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DENTAL  PHYSIOLOGY 

AND 

ORAL  HYGIENE 


I3y 
DAVID  STANLEY  HILL,  D.  D.  S. 
Eflangham,  Illinois. 


FIRST  EDITION 

Illustrated. 


The  LeCrone  Press 
Effingham,  111. 
1917. 


Copyright  1917  by 

DAVID   STANLEY  HILL,  D.    D.    S. 

All  Riehts  Reserved. 


DEDICATED 
TO  MY  MOTHER, 

MRS.  MARGARET  HILL, 

whose  example  has  been  an  inspiration  to  me;; 

AND 
TO  MY  SISTER, 

VIOLA  HILL, 

whose  loyal  assistance  has  contributed  much  to  any 
success  I  may  attain. 


PREFACE. 


Modern  dentistry  is  devoting  much  effort  toward- 
preventing  and  removing  the  cause  of  disease,  as  well- 
as  repairing  damage  after  bad  habits  have  caused  de- 
cay of  the  teeth.  Medical'  men  assert  that  many  of 
the  infectious  and  contagious  diseases  find  their  begin- 
ning in  unclean  oral  conditions. 

Disease  contributes  toward  poverty  and  crime.      In 
any    community   where    right   living    conditions    are- 
practiced,  poverty  and  disease  decrease. 

People  are  very  much  interested  in  their  own  wel-- 
fare,  and  are  anxious  to  know  of  anything  that  will  aid 
them  in  preserving  their  health  and  good  appearance. 
Unfortunately,  many  people  neglect  or  avoid  seeking 
dental  advice  and  aid  until  pain  prompts  them  to  call 
on  the  dentist. 

Often  serious  damage  has  been  done,  which  it  may/ 
be  too  late  to  remedy. 

The  time  to  begin  the  care  of  the  teeth  is  in  infancy. : 
The  children  are  not  responsible  for  the  neglected 
state  of  their  teeth.      The  careless  or  ignorant  parent, 
is  to  blame  for  the  condition. 

Diseased  conditions  put  a  handicap  on  the  child,  re- 
tarding mental  and  physical  development. 

School  teachers  are  doing  a  good  work  in  teaching.: 

—7— 


PREFACE. 

habits  of  personal  cleanliness;  but  parents  must  co- 
operate. Many  children  are  injured  by  bad  oral  hab- 
its long  before  the  school  age. 

In  a  period  of  ten  years'  practice,  I  have  often  been 
asked  questions  relative  to  the  care  of  the  teeth. 
People  of  otherwise  high  intelligence  show  a  very  lim- 
ited understanding  when  it  comes  to  a  knowledge  of  the 
Tteeth,  especially  the  care  and  preservation  of  the  tem- 
porary teeth. 

This  is  the  most  vital  time  of  the  child's  life,  and  mis- 
takes made  here  may  leave  their  mark  throughout  life. 

Start  the  child  right  and  keep  him  right  the  first 
^even  years  of  his  life,  and  he  will  take  care  of  himself 
afterward.  If  you  neglect  your  child  while  he  is  young 
and  unable  to  care  for  himself,  he  will  feel  a  resent- 
ment when  he  grows  old  enough  to  realize  your 
neglect. 

Repeatedly  and  methodically  going  over  a  subject  is 
the  best  known  method  of  teaching,  so  that  facts  sink 
in  and  are  digested  by  the  reader.  For  this  very 
Teason  of  emphasis  the  author  has  purposely  repeated 
some  subjects. 

In  this  little  book  I  have  tried  to  convey  informa- 
tion which  will  be  of  service  and  promote  better  care 
of  the  teeth,  which  means  better  health  to  the  individ- 
ual.   If  I  have  succeeded  I  shall  feel  well  rewarded. 

In  writing  this  little  book,  I  have  read  many  books 

and  magazine  articles.  An  effort  has  been  made  to  give 

credit  to  those  who  have  aided.  Dr.  Victor  C.  Bell's 

''Topular  Essays  on  the  Care  of  the  Teeth  an^  Mouth," 

—8— 


PREFACE. 

have  given  me  some  excellent  ideas.  From  The  Dental 
Cosmos  and  The  Dental  Digest  many  helpful  ideas 
have  been  used.  If  proper  credit  has  not  been  given 
here,  the  author  will  be  glad  to  rectify  the  mistake  in: 
the  next  edition,  if  the  book  should  merit  one. 

I  desire  here  to  express  my  thanks  to  those  wha 
have  helped  me  in  the  preparation  of  this  little  book; 
to  Doctors  Otto  U.  King,  Henry  L.  Whipple,  Hermann 
Prinz,  W.  A.  Evans,  L.  C.  Burgard,  William  W. 
Belcher,  William  G.  Ebersole,  George  T.  Weber,  and  F. 
B.  01  win,  and  to  Doctors  Thomas  B.  Hartzell  and  E. 
A.  Bogue,  for  the  use  of  their  illustrations  and  assist- 
ance; also  to  the  Columbus  Dental  Manufacturing 
Co.,  The  S.  S.  White  Dental  Manufacturing  Co.,  P. 
Blakiston's  Son  &  Co.,  The  Blue  Island  Specialty  Co.,. 
and  The  National  Mouth  Hygiene  Association,  for  the 
use  of  illustrations. 

Also  to  Superintendent  0.  C.  Bailey  and  Professor 
W.  B.  Bunn,  of  Effingham,  for  their  kindly  assistance- 
in  reading  proof. 

David  Stanley  Hill,  D.  D.  S., 

Effingham,  III.,  May  1,  1917. 


—9- 


TABLE  OF  CONTENTS. 
CHAPTER  PAGE 

I.  The  Digestive  System 13 

II.  The  Temporary  Teeth 30 

III.  Children's  Teeth 43 

IV.  Oral  Hygiene,  and  Dental  and 

Medical  Examination  of  School 

Children 55 

V.    Orthodontia,  or  Straightening 

Irregular  Teeth 72 

VI.    Filling  and  Treating  Teeth      ...  85 

VII.     Crown  and  Bridge  Work     ....  99 

VIH.     Care  OF  the  Teeth  and  Mouth  .     .     .  110 

IX.    Extracting  Teeth  and  Oral  Surgery  .  122 

X.    Artificial  Teeth 133 

XI.    Diseases  of  the  Mouth,  and 

First  Aid  Remedies 144 

XII.    Some  Information  About  Dentistry  .  156 

Glossary    . 165 


—10— 


LIST   OF   ILLUSTRATIONS. 
FIGURE  PAGE 

I.  The  Digestive  System 16 

II.  The  Appendix .25 

III.  The  Temporary  Teeth  at  Age  Two 

Years  (upper)       . 30 

IV.  Irregular  Teeth       .      .      ...     .     .     '3^ 

V.  The  First  Permanent  Molars      .      .      .      .  43 

VI.  The  Ten  Upper  Deciduous  Teeth, 

Age  Five  Years 72: 

VII.  Models  of  Irregular  Teeth      .      ...     74 

VIII.  Case  of  V  Shaped  Upper  Arch      .     .     .  75- 

IX.  A  Mouth  Breather  (front  view)   ...  81 

X.  A  Mouth  Breather  (side  view)   .      .      .     .  8L 

XI.  A  Mouth  Breather.    After  Widening 

OF  THE  Arches  and  Straightening 

THE  Teeth  (front  view)       ....     82 

XII.  A  Mouth  Breather.    x4fter  Widening 

of  the  Arches  and  Straightening 

the  Teeth   (side  view)        ....   82: 

XIII.  Cuspid  Teeth,  Ground  Down,  Show- 

ing Enamel,  Dentine,  Pulp  Cham- 
ber, AND  Roots  of  Teeth      .      .     .     .     87 

XIV.  Decayed  Teeth 93 

XV.  Decayed  Teeth,  Restored  by  Filling      .     94 

XVI.  Root  Canals  in  Teeth,  Filled      .     .     .95 

XVII.  Bad  Eyes,  From  Abscessed  Teeth  .     .     9^ 

XVIII.  Diseased  Heart,  From  Abscessed  Teeth  97 

—11— 


LIST   OF   ILLUSTRATIONS. 

FIGURE  PAGE 

•XIX.   Defoemed  Hand,  From  Dental  Abscesses    98 

XX.  Tooth  Which  Needs  Crowning      .     .     .  101 

XXI.  Tooth  Root  Prepared  for  Crown  .     .     101 

XXII.  Porcelain  Crown  Completed  ....  102 

XXIII.  A  Richmond  Crown 104 

XXIV.  A  Gold  Shell  Crown      .     .     .     ,     .  104 

XXV.  Teeth  Needing  Crown  and  Bridge  Work  107 

XXVI.  Teeth  Prepared  for  Crowns      .     .     .  107 

XXVII.  Crown  and  Caps  for  Bridge  Work  .     108 

XXVIII.  Spaces  Filled  in,  for  Bridge  Teeth    108 

XXIX.  Bridge  Soldered  Together      ...     108 

XXX.  Bridge,  Porcelain  Teeth  Attached      .  108 

XXXI.  A  Three-Tooth  Bridge       ....     109 

XXXII.  A  Tongue  Scraper 114 

XXXIII.  Brushes^Adult's,  Youth's,  Child'«  119 
XXXIV-A-B.  How  TO  Brush  the  Teeth  .  .  120 
XXXIV.-C.  How  TO  Brush  the  Teeth  .  .  .121 
XXXV.    Irregular  Teeth,  Caused  by 

Removing  One  Tooth 12.3 

X^XXVI.    Artificial  Upper  Teeth     ....   134 

XXXVII.  Artificial  Lower  Teeth      .      .      .     135 

XXXVIII.  Full  Upper  and  Lower  Plates         137 

XXXIX.  A  Plate  Brush 142 

XL.    Nerves  of  Head  and  Face      ....     151 


—12- 


THE  DIGESTIVE  SYSTEM. 


CHAPTER  I. 

The  apparatus  for  the  digestion  of  the  food  consists 
of  the  ALIMENTARY  CANAL  and  certain  ACCES- 
SORY ORGANS.  The  Alimentary  Canal  (Fig.  1), 
commencing  with  the  mouth,  lies  in  the  neck,  in  front 
of  the  spine,  passes  through  the  thoracic  cavity,  pierc- 
ing the  diaphragm,  and  continues  in  a  tortuous  course 
through  the  abdomen  and  a  straighter  course  through 
the  pelvis.  It  is  about  thirty  feet  long,  and  varies  in 
diameter.  Its  principal  parts  are  the  MOUTH, 
PHARYNX,  OESOPHAGUS,  STOMACH,  SMALL 
INTESTINE,  and  LARGE  INTESTINE. 

Its  lining,  mucous  membrane,  is  modified  in  each 
section  according  to  the  function  of  the  particular 
part,  and  is  continuous  at  both  extremities  with  the 
skin.  The  muscular  fibres  of  the  canal  are  mostly  of 
the  UNSTRIPED  variety,  and  are  arranged  length- 
wise and  circularly  in  the  tubular  portions.  Its  layers, 
serous,  muscular,  areolar,  and  mucous,  are  well  sup- 
plied with  blood  vessels.  The  tube  has  nerve  ganglia, 
and  receives  fibres  from  the  central  and  sympathetic 
systems. 

For  convenience  in  the  study  of  the  Alimentary 
Canal,  it  may  be  divided  into  its  various  parts  as 
follows : 

—13— 


The  Salivary  Glands 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

THE  ALIMENTARY  CANAL. 

The  Mouth,  The  Stomach, 

The  Pharynx,  The  Small  Intestine, 

The  Oesophagus,        The  Large  Intestine. 

ACCESSORY  ORGANS. 

[Deciduous,  or  Baby  Teeth,  20  in  Number, 
The  Teeth 

[The  Permanent  Teeth,  32  in  Number. 

fThe  Parotid  Glands, 

The  Submaxillary  Glands, 

The  Sublingual  Glands. 

The  Liver,     The  Pancreas. 

THE  MOUTH. — The  Alimentary  Canal  commences 
with  the  mouth.  It  is  bounded  by  the  lips  in  front  and 
the  soft  palate  behind.  Between  the  anterior  and 
posterior  arches  of  the  soft  palate  are  situated  the 
TONSILS,  one  on  each  side.  A  Tonsil  consists  of  an 
elevation  of  the  mucous  membrane,  presenting  several 
openings  which  lead  into  recesses,  in  the  walls  of  which 
are  placed  nodules  of  lymphoid  tissue.  The  Tonsils  will 
be  mentioned  again  in  a  following  chapter. 

The  mouth  is  bounded  above  by  the  hard  palate, 
below  by  soft  structures,  and  on  the  sides  by  the 
cheeks,  and  is  lined  with  mucous  membrane.  It  con- 
tains the  tongue  and  the  teeth.  When  closed  the  cavity 
is  completely  filled. 

The  mouth  is  the  main  entrance  to  the  alimentary 
canal,  and  with  its  appendages,  is  of  great  service 
in  speech. 

—14— 


THE  DIGESTIVE  SYSTEM 

Opening  into  the  mouth  are  a  large  number  of  little 
mucous  glands.  The  salivary  glands  also  pour  their 
secretions  into  the  mouth. 

The  Tongue  is  a  muscular  organ,  covered  with 
mucous  membrane.  The  muscles  which  form  the  great- 
er part  of  the  tongue  (intrinsic  muscles),  are  termed 
Unguals;  and  by  these,  which  are  attached  to  the 
mucous  membrane,  its  smaller  and  more  delicate  move- 
ments are  perform.ed.  By  other  muscles  (extrinsic 
muscles),  the  tongue  is  fixed  to  the  surrounding  parts, 
and  by  these  its  larger  movements  are  controlled. 

The  mucous  membrane  of  the  tongue  resembles 
other  mucous  membranes  in  essential  points  of  struc- 
ture, but  in  addition,  contains  PAPILLAE,  peculiar  to 
itself.  The  tongue  is  also  beset  with  numerous  mu- 
cous glands  and  lymphoid  nodules.  The  Papillae  give 
the  characteristic  roughness  to  the  tongue. 

The  Peripheral  Organs  of  the  sense  of  taste  consist 
of  groups  of  modified  epithelial  cells,  termed  TASTE 
BUDS,  which  are  found  on  certain  parts  of  the 
tongue  and  its  immediate  neighborhood. 

The  mouth  contains  the  teeth,  which  are  used  in 
masticating  the  food.  The  human  subject  is  provid- 
ed with  two  sets  of  teeth,  which  make  their  appear- 
ance at  different  periods  of  life.  The  first  set  appear 
in  childhood,  and  are  called  the  TEMPORARY,  DE- 
CIDUOUS, or  MILK  TEETH,  of  which  there  are 
twenty,  ten  in  the  lower  and  ten  in  the  upper  jaw. 

The  second  set  appear  later  in  life,  and  are  called 

—15— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


the  PERMANENT  TEETH.  There  are  thirty-two 
of  these.  The  Teeth  will  be  taken  up  in  a  separate 
chapter  and  more  fully  discussed. 

THE  PHARYNX.— The  Pharynx  is  the  enlarged 
upper  part  of  the  alimentary  canal,  which  lies  behind 
the  mouth.     It  is  a  musculo-membranous  open  sac,. 

Nasal  Cavity 
Palate 
Tongue: 


OESOPHAGUS 


Gall  Bladder 
LivEa — 


Duodenum 
Small  Intestine 
Appendik 


Pylorus 
Stomach 
Pancreas 


Large 


Intestine 


Figure  I.  The  Digestive  System.      (Photograph  of  pen  drawing,) 

—16— 


THE  DIGESTIVE  SYSTEM 

wider  above  than  below,  and  is  that  part  of  the  ali- 
mentary canal  which  intervenes  between  the  mouth 
and  the  oesophagus.  In  the  middle  portion  it  is  com- 
mon to  both  food  and  air,  conveying  food  to  the 
oesophagus,  and  air  to  the  larynx,  and  thence  into  the 
lungs.  The  Pharynx  has  seven  openings  through 
which  it  communicates  with  neighboring  cavities. 
These  are  the  two  posterior  nares,  opening  into  the 
nasal  cavity  in  front;  the  two  Eustachian  Tubes  on 
the  sides,  opening  to  the  ears;  the  opening  into  the 
mouth ;  the  opening  into  the  larynx ;  and  the  opening, 
at  the  lower  end,  into  the  Oesophagus. 

The  OESOPHAGUS.— The  Oesophagus  or  Gullet,  is 
the  portion  of  the  digestive  canal  which  intervenes  be- 
tween the  pharynx,  above,  and  the  stomach,  below. 
With  the  exception  of  the  pylorus,  it  is  the  narrowest 
part  of  the  alimentary  canal.  It  is  also  the  most  muscu- 
lar part.  It  is  a  muscular  tube,  nine  or  ten  inches  in 
length.  Its  breadth  varies  from  a  half  inch  in  its  empty 
contracted  state,  to  an  inch  or  more  in  its  fully  distend- 
ed state. 

The  Oesophagus  is  made  up  of  three  proper  coats, — 
the  outer  or  muscular,  the  middle  or  sub-mucous,  and 
the  inner  or  mucous.  In  addition  it  is  surrounded  by 
an  outer  covering  of  areolar  tissue,  by  which  it  is 
loosely  connected  to  the  various  structures  related 
to  it  in  its  course.  This  loose  covering  permits  of  its 
free  movements  and  of  its  increase  in  size,  or  of  its 
contraction  during  the  act  of  swallowing.  The  MUS- 
CULAR coat  is  composed  of  two  planes  or  layers  of 

—17— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

fibres,  of  considerable  thickness,  an  outer  or  a  longi- 
tudinal, and  an  inner  of  circular  fibres. 

The  SUB-MUCOUS  or  areolar  coat  connects  loosely 
the  mucous  and  muscular  coats.  It  is  composed  of 
areolar  tissue,  and  is  of  considerable  thickness,  in  or- 
der to  allow  of  the  expansion  of  the  tube  during  swal- 
lowing. By  loosely  connecting  the  mucous  membrane 
to  the  muscular  coat,  it  permits  the  mucous  coat  to  be 
thrown  into  folds  when  empty.  The  sub-mucous  coat 
contains  blood  vessels,  nerves,  and  oesophageal  glands. 
These  glands  are  mucous  glands. 

The  MUCOUS  coat  is  'thick,  and  is  disposed  in 
longitudinal  folds,  which  disappear  when  the  tube  is 
distended.  This  coat  has  numerous  glands  which  dif- 
fer from  the  mucous  glands  of  the  sub-mucous  tissue. 
"They  are  branched  and  tubular,  and  are  called  super- 
ficial glands. 

The  muscular  coat  also  contains  glands,  which  dif- 
fer from  the  mucous  glands  of  the  sub-mucous  tissue. 

Swallowing,  or  Deglutition,  is  divided  into  three 
stages:  (1) .  The  mass  of  food  is  forced  by  the  tongue 
through  the  fauces  into  the  pharynx.  This  is  under  the 
control  of  the  will.  (2).  In  this  stage  the  bolus  must 
pass  through  that  part  of  the  pharynx  common  to  food 
and  air,  and  hence  it  must  be  quickly  performed.  This 
is  done  by  a  series  of  contractions  controlled  by  the 
reflex  centers,  and  not  by  the  will.  (3).  The  passage 
of  the  food  through  the  oesophagus  is  performed  by 
progressive  muscular  contractions,  from  above  down- 
wards, and  is  independent  of  the  will,  and  which  act 

—18— 


THE  DIGESTIVE  SYSTEM 

carries  the  food  into  the  stomach,  which  is  the  next 
part  of  the  Alimentary  Canal. 

The  STOMACH.— The  Stomach  is  the  principal  or- 
gan of  digestion.  It  is  the  most  dilated  part  of  the 
alimentary  canal,  and  is  placed  on  the  left  side  of  the 
abdomen,  and  under  the  DIAPHRAGM,  between  the 
terminus  of  the  oesophagus  and  the  commencement  of 
the  small  intestine. 

The  form  and  size  of  the  stomach  varies  because  of 
varied  conditions,  but  as  a  rule,  when  distended,  it 
assumes  the  form  of  an  irregular  pear.  Probably  no 
organ  in  the  body  varies  more  in  size,  within  the  limits 
of  health,  than  the  stomach.  Its  length,  in  its  fulljr 
distended  condition,  is  about  ten  to  eleven  inches,  and 
its  greatest  diameter  not  more  than  four  to  four  and 
a  half  inches ;  whilst  its  greatest  capacity  in  the  aver- 
age state  rarely  exceeds  five  pints. 

The  DIAPHRAGM  is  a  thin  musculo-fibrous  sep- 
tum, which  separates  the  thorax  from  the  abdomen, 
forming  the  floor  of  the  thorax  and  the  roof  of  the 
abdomen.  The  Diaphragm  is  the  muscle  involved  in 
hiccough.  Hiccough  is  an  ijivoluntary  sudden  contrac- 
tion of  the  diaphragm,  causing  an  inspiration,  which  is 
suddenly  arrested  by  the  closing  of  the  glottis,  causing 
a  characteristic  sound.  It  arises  from  gastric  and  re- 
flex irritation.  (Note  1  ).  The  Oesophagus  pierces  the 
Diaphragm  in  its  downward  course  to  the  stomach. 


Note    1.    The   true    Glottis   is   the    apparatus    for   producing   tone^ 
and  is  formed  by  the  true   vocal  cords. 

—19— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

STRUCTURE  OF  THE  STOMACH.     The  Stomach 
is  composed  of  four  coats.  (1) .  The  outer  or  serous  lay- 
er— ^thin,    transparent  and  smooth — is  a  part  of  the 
peritoneal  lining  of  the  abdomen,  and  is  also  called  the 
external  or  peritoneal  coat,  (2).  The  muscular,  whose 
fibres  are  arranged  lengthwise,   circularly,   and   ob- 
liquely, making  three  separate  sets  of  layers  of  fibres. 
The  churning  motions  of  these  muscles  cause  the  con- 
tents of  the  stomach  to  be  well  mixed  up.  The  action 
of  these  muscles  is  called  peristalsis.  (3).  The  areolar 
or  sub-mucous  coat  consists  of  a  layer  of  strong  but 
loose  connective  tissue,  which  lies  between,  and  unites 
the  muscular  and  mucous  coats.       It  is  more  loosely 
attached  to  the  former  and  more  closely  to  the  latter 
coat,  and  forms  a  bed  in  which  the  vessels  and  nerves 
break    up    before    entering    the    mucous    membrane. 
(4).  The  mucous  or  inner  layer  is  thick.  Its  surface  is 
smooth,  soft  and  velvety.  In  the  fresh  state  it  is  of  a 
pinkish  tinge  at  the  pyloric  end,  and  of  a  red  or  red- 
dish brown  color  over  the  rest  of  the  surface.  During 
the  contracted  state  of  the  stomach,  the  membrane  is 
thrown  into  numerous  plaits  or  rugae,  caused  by  the 
contraction  of  the  three  outer  coats,  which  are  ex- 
tensile, while  the  inextensile  mucous  coat,  as  a  result 
of  its  lack  of  elasticity,  is  thrown  into  numerous  promi- 
nent folds,  or  rugae,  which  project  into  the  interior, 
and,  as  it  were,  occupy  the  cavity  of  the  contracted 
organ.  They  disappear  when  the  stomach  is  distended. 
A  constant  fold  exists  at  the  pylorus.  It  is  called  the 
PYLORIC  VALVE,  and  is  produced  by  the  presence 

—20— 


THE  DIGESTIVE  SYSTEM 

beneath  it  of  the  Sphincter  muscle.  This  mucous  layer 
is  composed  of  a  corium  of  fine  connective  tissue, 
which  approaches  closely  in  structure  to  adenoid 
tissue.  This  tissue  supports  the  tubular  glands,  of 
which  the  superficial  and  chief  part  of  the  mucous 
membrane  is  composed,  and  assists  in  binding  them 
together.  The  glands  are  separated  from  the  rest  of 
the  mucous  membrane  by  a  very  fine  homogenous 
basement  membrane.  The  corium  is  covered  with  a 
layer  of  columnar  epithelium,  which  passes  down  in- 
to the  mouths  of  the  glands.  At  the  deepest  part  of 
the  mucous  membrane  are  two  thin  layers  (circular 
and  longitudinal)  of  unstriped  muscular  fibres,  called 
the  MUSCULARIUS  MUCOSAE,  which  separate  the 
miucous  membrane  from  the  scanty  sub-mucous  tissue. 

FUNCTION  OF  THE  STOMACH.  The  mucous  or 
inner  layer  of  the  stomach  is  provided  with 
a  multitude  of  glands,  which  secrete  GASTRIC 
JUICE.  This  fluid  is  colorless  and  watery,  and 
has  a  sour  taste  and  odor.  It  contains  free  hydro- 
chloric acid,  and  a  ferment  body  called  pepsin.  The 
€ASTRIC  GLANDS  are  of  three  kinds :  the  TRUE 
CASTRIC  GLANDS,  the  PYLORIC  GLANDS  and  the 
CARDIAC  GLANDS.  The  True  Gastric  Glands  are 
also  called  PEPTIC  GLANDS.  They  are  distributed 
throughout  the  entire  fundus,  or  main  body  of  the 
stomach,  and  may  even  be  found  at  the  pylorus.  These 
gastric  glands  secrete  pepsin.  Between  these  glands 
and  the  basement  membrane  are  the  PARIETAL  or 

—21— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

OXYNTIC  CELLS.  The  parietal  cells  secrete  the  acid 
of  the  gastric  juice. 

The  PYLORIC  GLANDS  are  branched  tubular 
glands,  and  secrete  mucus.  They  are  placed  most 
plentifully    about    the    pylorus.  The    CARDIAC 

GLANDS  are  found  about  the  Oesophageal  orifice. 
They  resemble  the  pyloric  glands.  The  secretion  of 
these  glands,  the  GASTRIC  JUICE,  has  the  power  of 
changing  the  insoluble  proteids,  (beef,  eggs,  legumes), 
into  soluble  and  diffusible  substances,  called  PEP- 
TONES. The  muscular  contractions  churn  the  con- 
tents of  the  stomach  and  thoroughly  mix  the  food 
with  mucus  and  juice.  The  motions  are  independent 
of  the  will.  When  a  portion  of  the  food  is  reduced  to 
a  soft  pulp,  it  is  called  CHYME.  The  Chyme,  as  it  i& 
formed,  is  allowed  to  escape  intermittently  through 
the  pylorus  into  the  small  intestine,  where  the  digest- 
ive processes  are  continued.  By  a  reference  to  Figure 
1,  the  course  of  the  food  may  be  traced  and  an  idea 
obtained  of  the  various  parts  of  the  digestive  tract, 
which  will  enable  the  reader  to  better  understand  the 
following  chapters. 

The  INTESTINES.— The  Intestinal  canal  is  divided 
into  two  chief  parts,  named,  from  their  differences, 
in  diameter,  the  SMALL  and  LARGE  INTESTINE. 
These  are  continuous  with  each  other,  and  communi-^ 
cate  with  each  other  by  means  of  an  opening  guarded 
by  a  valve,  called  the  ILEO-CAECAL  VALVE,  which 
allows  the  passage  of  the  products  of  digestion  from 
the  small  into  the  large  intestine,  but  not,  under  ordi-^ 

—22— 


THE  DIGESTIVE  SYSTEM 

nary  conditions,  in  the  opposite  direction. 

The  SMALL  INTESTINE.— The  average  lengi:h  of 
the  small  intestine,  in  the  adult,  is  about  twenty 
feet.  It  commences  at  the  PYLORIC  ORIFICE 
or  PYLORUS,  the  opening  through  which  the  stomach 
communicates  with  the  Duodenum,  which  is  the  name 
of  the  first  part  of  the  small  intestine. 

The  DUODENUM  extends  for  eight  or  ten  inches 
beyond  the  pylorus.  The  JUJUNUM  is  the  next  divis- 
ion, and  forms  about  two-fifths  of  the  whole,  and  the 
ILEUM  the  other  three-fifths  of  the  canal.  The  wall 
of  the  intestine,  like  that  of  the  stomach,  is  made  up 
of  four  coats,  namely,  the  serous,  muscular,  sub- 
mucous, and  mucous.  The  small  intestine  lies  in  coils 
in  the  middle  and  lower  part  of  the  abdomen.  It  is 
from  one  to  one  and  three-fourths  of  an  inch  in  diam- 
eter. It  is  supported  and  held  in  place  by  a  broad, 
double  fold  of  the  peritoneum,  enclosing  blood-vessels 
and  nerves,  called  the  messentery.  The  ducts  of  the 
liver  and  pancreas  empty  into  the  first  part  of  the 
small  intestine,  the  Duodenum. 

The  interior  of  the  small  intestine  shows  many 
transverse  projections,  extending  half  or  two-thirds 
around  the  tube,  called  the  valvulae  conniventes,  and 
.an  immense  number  of  threadlike  processes,  the 
VILLI.  When  immersed  in  water,  these  villi  stand  up, 
^nd  they  then  resemble  the  ''pile"  of  velvet.  There  are 
many  glands  in  the  mucous  membrane  layer.  • 

The  movements  forward  of  the  contents  of  the  in- 
testine depend  upon  the  longitudinal  and  circular  mus- 

—23— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

cular  fibres  of  the  tube.  This  peristaltic  action  consists 
of  slow,  successive,  wavelike  contractions,  chiefly  of 
the  circular  fibres,  extending  from  the  upper  part 
gradually  to  the  lower  part  of  the  canal.  However, 
these  contractions  or  rythmic  segmentations  may  com- 
mence at  any  point  of  the  intestine,  and  extend  in  a 
wavelike  manner  along  the  tube.  The  series  of  con^ 
tractions  force  the  intestinal  contents  along.  These 
contractions  may  occur  independently  of  the  central 
nervous  system.  Their  essential  stimuli  arise  in  the 
nerve  ganglia  seated  in  the  intestional  walls,  but  the 
movements  are  modified  by  influences  passing  over  the 
sympathetic  nerves. 

Peyer's  patches  are  found  only  in  the  small  intes- 
tine. They  consist  of  aggregated  groups  of  lymphoid 
nodules.  They  vary  from  one  to  three  inches  in  length, 
and  are  about  half  an  inch  in  width,  chiefly  of  an  oval 
form,  their  long  axes  being  parallel  with  the  intes- 
tine. The  chief  bowel  lesion  in  typhoid  fever  is  found 
in  Peyer's  patches  and  the  solitary  glands,  and  it  is 
from  their  ulceration  and  perforation  that  hem- 
orrhage results.  . 

The  LARGE  INTESTINE.~The  Large  Intestine  is 
from  five  to  six  feet  long,  being  about  one-fifth 
of  the  whole  extent  of  the  intestinal  canal.  It  is 
from  one  and  a  half  to  two  and  a  half  inches  wide, 
and  has  a  wrinkled  and  saculated  appearance.  Its 
mucous  membrane  is  smooth,  and  has,  in  depressions,  a 
few  glands.    There  are  no  villi. 

Like  the  small  intestine,  the  large  intestine  is  con- 

—24— 


THE  DIGESTIVE  SYSTEM 

structed  of  four  coats — the  serous,  muscular,  sub- 
mucous and  mucous.  The  ileo-caecal  valve  is  situated 
at  the  place  of  junction  of  the  small  with  the  large 
intestine,  and  guards  against  any  influx  of  the  con- 
tents of  the  latter  back  into  the  small  intestine. 

The  Caecum,  the  commencement  of  the  large  intes- 
tine, is  the  large  blind  pouch,  or  cul-de-sac,  situated 
below  the  ileo-caecal  valve.  Its  name  is  derived  from 
OAECUS,  meaning  blind.     The  Appendix,   (appendix 


Small 
ntestine 


C/\e:cum 


Figure  II.  The  first  part  of  the  large  intestine,  show- 
ing the  appendix.  (Photograph  from  a  pen  drawing.) 

—25— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

vermiformis) ,  is  a  long,  narrow,  worm-shaped,  muscu- 
lo-membranous  tube, which  starts  from  what  was  origi- 
nally the  apex  of  the  Caecum.  The  canal  of  the  Ap- 
pendix is  small  and  extends  throughout  the  length  of 
the  tube.    (Figure  2.) 

The  Appendix  is  very  susceptible  to  inflamation, 
the  condition  being  known  as  appendicitis. 

The  large  intestine  differs  from  the  small  intestine 
in  its  greater  size,  its  more  fixed  position,  its  saculat- 
ed  form,  and  certain  peritoneal  pouches  containing  fat. 
There  are  three  divisions  of  the  large  intestine,  but 
in  a  work  which  primarily  concerns  dental  subjects, 
they  will  not  be  fully  discussed. 

The  LIVER  and  PANCREAS.— The  Liver  is  the 
largest  gland  in  the  body,  and  is  situated  in  the  up- 
per and  right  part  of  the  abdominal  cavity.  In  the 
male  it  weighs  from  fifty  to  sixty  ounces ;  in  the  fe- 
male from  forty  to  fifty  ounces.  The  liver  is  an  ex- 
tremely vascular  organ,  and  receives  its  supply  of 
blood  from  two  distinct  sources, — ^namely,  from  the 
PORTAL  VEIN  and  from  the  HEPATIC  ARTERY, 
while  the  blood  is  returned  from  it  into  the  ven^,  cava 
inferior  by  the  Hepatic  Veins. 

Its  secretion,  the  bile,  is  conveyed  from  it  by  the 
hepatic  duct,  either  directly  into  the  intestine,  or, 
when  digestion  is  not  going  on,  into  the  Cystic  duct, 
and  thence  into  the  gall  bladder,  where  it  accumulates 
until  needed.  In  addition  to  the  secretion  of  the  bile, 
the  liver  plays  an  important  part  in  the  metabolism  of 
both  carbohydrates  and  nitrogenous  materials.    Bile 

—26— 


THE  DIGESTIVE  SYSTEM 

is  being  continually  forced  into  the  intestines,  but 
there  is  an  increased  discharge  immediately  upon  the 
arrival  of  food  in  the  duodenum. 

The  PANCREAS  is  a  long,  narrow,  pinkish  gland.  It 
is  found  behind  the  lower  border  of  the  stomach.  In 
structure  it  resembles  the  salivary  glands.  Its  duct 
discharges  into  the  duodenum.  Its  secretion  is  viscid, 
colorless,  odorless,  and  of  an  alkaline  reaction.  The 
Pancreatic  Juice  "contains  a  ferment  which  breaks  up 
fat,  a  ferment  which  converts  starch  into  sugar,  a  fer- 
ment which  curdles  milk,  and  a  ferment  which  digests 
proteid  material."  * 

The  SALIVARY  GLANDS.— Numerous  glands  exist 
in  the  lips,  cheeks,  palate  and  tongue.  They  are  mostly 
mucous  glands,  but  by  the  term  Salivary  Glands  are 
usually  understood  the  three  chief  glandular  masses 
on  each  side  of  the  face.  These  are  the  principal 
salivary  glands.  They  communicate  with  the  mouth, 
pour  their  secretion  into  its  cavity,  and  are  named, 
respectively,  the  PAROTID,  SUBMAXILLARY,  and 
SUB-LINGUAL  GLANDS. 

The  PAROTID  GLANDS,  so  called  from  being 
placed  near  the  ears,  are  the  largest  of  the  three  sali- 
vary glands,  varying  in  weight  from  half  an  ounce  to 
an  ounce  each.  They  lie  one  upon  each  side  of  the  face 
immediately  below  and  in  front  of  the  external  ear. 
Their  outer  surface  is  covered  by  the  integument  and 
parotid  fascia.  The  ducts  of  the  parotid  glands  (or 
Stenson's  Ducts),  are  about  two  inches  and  a  half  in 
length.       They  open  upon  the  inner  surfaces  of  the 

— —  27. 

*Grav's  Anatomy.  •" 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

cheeks  by  small  orifices  opposite  the  second  molar 
teeth  of  the  upper  jaw. 

The  SUBMAXILLARY  GLAND  is  situated  below 
the  jaw,  in  the  anterior  part  of  the  submaxillary  tri- 
angle of  the  neck.  It  is  irregular  in  form  and  weighs- 
about  two  drachms.  The  duet  of  the  submaxillary^ 
gland,  or  Wharton's  Duct,  is  about  two  inches  long, 
and  opens  by  a  narrow  orifice  on  the  summit  of  a  small 
papillae  at  the  side  of  the  fraenum  linguae,  and  close 
to  its  fellow  on  the  opposite  side. 

The  SUBLINGUAL  GLAND  is  the  smallest  of  the 
salivary  glands.  It  is  situated  beneath  the  mucous 
membrane  of  the  floor  of  the  mouth,  at  the  side  of  the 
fraenum  linguae,  in  contact  with  the  inner  surface 
of  the  lower  jaw.  It  is  narrow,  flattened,  and 
shaped  somewhat  like  an  almond,  and  weighs  about  a 
drachm.  Its  excretory  ducts  are  from  eight  to  twenty^ 
in  number.  They  open  separately  into  the  mouth  back 
of  Wharton's  Duct,  and  upon  a  fold  of  the  mucous 
membrane.  One  or  more  ducts  sometimes  join  to  form 
a  tube  which  opens  into  the  duct  of  Wharton,  or  re-^ 
mains  independent,  opening  close  to  Wharton's  duct. 
This  duct  is  called  the  DUCT  OF  BARTHOLIN. 

MUCOUS  GLANDS.— Besides  the  salivary  glands 
proper,  numerous  other  glands  are  found  in  the  mouth. 
They  appear  to  secrete  mucus  only,  which  serves  ta 
keep  the  mouth  moist  during  the  intervals  of  the 
salivary  secretion,  and  which  is  mixed  with  that 
secretion  in  swallowing. 

DIGESTION. — ^By  a  careful  study  of  the  digestive 

—28— 


THE  DIGESTIVE  SYSTEM 

system  a  better  idea  may  be  had  of  the  effects  diseased 
teeth  have  on  the  general  health.  Good  health  depends 
to  a  great  extent  on  a  healthy  alimentary  tract.  Good^ 
teeth  permit  the  food  to  be  well  masticated.  A  clean 
mouth  will  not  contaminate  the  food  eaten.  This  pro- 
motes good  digestion.  The  mouth  is  the  entrance  to 
the  alimentary  canal,  and  here  all  food  taken  receives 
the  first  preparation  in  the  process  of  digestion.  It  is 
therefore  important  that  this  preparation  be  thor- 
ough, and  that  the  mouth  be  free  from  disease,  to- 
avoid  infecting  the  food  supply.  A  clean  mouth  and  a 
good  set  of  teeth  to  properly  masticate  the  food  wili 
do  much  to  insure  a  healthy  body  and  a  longer  life. 


--29— 


THE  TEMPORARY  TEETH. 


CHAPTER  II. 


The  mouth  of  the  infant  at  birth  contains  no  teeth, 
although  a  number,  partly  developed,  lie  embedded  in 
the  jaws  beneath  the  gums.  About  five  or  six  months 
later  teeth  begin  to  appear,  and  by  the  end  of  the 
second  year  a  set,  known  as  the  MILK  TEETH,  have 
been  ''cut",  or  come  in.  The  teeth  may  pierce  the  gum 
without  any  local  manifestations.  Very  frequently, 
however,  just  before  a  tooth  comes  through,  there  is 
noticed  a  little  swelling  and  redness  of  the  mucous 
membrane  overlying  it.  This  condition  may  be  accom- 
panied by  f  retf  ulness  and  an  increase  of  saliva,  but  the 
symptons  disappear  when  the  tooth  has  pierced  the 
gum. 

These  teeth 
are  the  tem- 
porary or  de- 
ciduous teeth, 
more  common- 
ly known  as 
the  milk  teeth. 
This  set  con- 
sists of  twenty 
teeth,  ten  in 
the   upper  jaw 

Fi.aiire    III.       Model    of    child's    month,    age     and  ten   in  the 
two  years,  showing  the  ten   temporary  teeth     , 

in    tlie    upper   Jaw.  lOWer  jaVf. 

—30— 


THE    TEMPORARY    TEETH 

The  following  table  will  give  an  idea  of  the  time  each 
temporary  tooth  comes  into  place : 

*     Central  Incisors, Fifth  to  Ninth  Month. 

Lateral  Incisors, Seventh  to  Ninth  Month, 

First  Molars, Fourteenth  to  Fifteenth  Month. 

Cuspids, Seventeenth  to  Eighteenth  Month- 
Second  Molars, .  .  Eighteenth  to  Twenty -fourth  Month. 

The  above  table  gives  the  average  time  of  eruption 
of  the  upper  teeth;  as  a  usual  thing,  the  lower  teetk 
erupt  about  one  month  earlier  than  the  upper  teeth. 
However,  the  limits  of  normal  variations  are  com- 
paratively wide.  Some  forward  children  may  get  their 
teeth  earlier,  while  others  may  run  over  the  normal 
two  year  period  a  few  weeks  or  months. 

Various  diseases  of  childhood  affect  the  teeth,  an 
example  of  which  is  Rickets,  a  disease  that  affects  the 
bony  structures  and  the  teeth. 

The  Temporary  teeth  last  but  a  short  time,  or  until 
they  are  replaced  by  the  Permanent  teeth.  This  fact 
leads  many  people  to  the  conclusion  that  the  Tem^ 
porary  teeth  are  not  of  much  importance.  This,  how- 
ever, is  a  mistaken  idea.  THE  TEMPORARY  TEETH 
ARE  VERY  IMPORTANT  TO  THE  GROWTH  AND 
DEVELOPMENT  OF  THE  CHILD. 

The  idea  that  the  Temporary  teeth  should  not  be 
taken  care  of,  and  that  they  should  be  taken  out  as 
soon  as  they  ache,  is  a  mistake,  and  does  harm  to  the 
growing  child. 

CLEAN  TEETH  DO  NOT  DECAY.— Therefore,  the 
child's  teeth  should  be  kept  clean.  As  soon  as  the  teeth 


* 


Compiled. 


-31- 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

appear,  they  should  be  carefully  watched,  for  they 
easily  begin  to  decay  at  this  time.  They  should  be 
cleaned  every  day  with  a  piece  of  soft  linen  or  cotton 
cloth.  The  mother  can  do  this  each  day.  Begin  when 
the  first  teeth  appear.  Watch  each  tooth  as  it  comes  in, 
and  keep  all  stain  or  any  deposit  from  forming  on  th^ 
teeth.  This  can  be  done  by  gently  wiping  the  surface 
of  the  tooth  with  a  soft  piece  of  linen  cloth,  removing 
any  stain  or  other  accumulation  that  may  be  on  the 
teeth. 

When  all  of  the  twenty  teeth  are  erupted,  a  soft 
brush  should  be  used.  Brush  the  baby's  teeth  regu- 
larly, and  do  the  work  of  cleaning  until  the  child  be- 
comes old  enough  to  brush  his  own  teeth.  By  that 
time  he  will  have  formed  the  habit  of  having  his 
mouth  clean,  and  most  children  will  be  willing  to 
Thrush  their  own  teeth  as  soon  as  they  are  old  enough 
to  handle  the  brush  for  themselves.  Once  a  child  learns 
the  physical  comfort  derived  from  a  clean  mouth,  he 
will  tolerate  no  other  condition,  and  no  one  will  have 
to  coax  him  to  brush  his  teeth. 

DECAYED  TEETH.— Should  the  teeth  have  been 
neglected,  and  decay  and  toothache  result,  they  should 
not  be  extracted  if  it  is  possible  to  save  them.  Nature 
provides  a  time  for  the  Temporary  teeth  to  be  re- 
moved. This  is  indicated  by  the  absorption  of  the 
roots,  and  the  loosening  of  the  crowns  in  preparation 
for  the  permanent  teeth.  Until  these  roots  are  ab- 
sorbed, and  the  crowns  loosened,  the  teeth  should  re- 
main in  place.  First;  because  the  child's  jaws  are  im- 

—32— 


THE    TEMPORARY   TEETH 

perfectly  developed  and  very  frail,  and  are  liable  to 
fracture  or  be  damaged  otherwise  by  bruising.  An 
injury  may  be  done  at  this  time  that  the  child  ma:^^ 
carry  through  life.  Second ;  if  these  teeth  are  extracted 
before  the  permanent  teeth  are  ready  to  come  in  and 
replace  them,  the  permanent  teeth  are  interfered  with. 
They  will  not  grow  in  their  natural  positions,  which 
makes  them  irregular  and  distorts  the  mouth,  and 
sometimes  the  facial  expression.  It  also  hinders  the 
work  of  mastication.  This  is  harmful  to  the  child,  and 
should  be  prevented.  Teeth  that  do  not  come  out  in 
time  to  permit  the  permanent  teeth  to  come  through, 
may  be  extracted,  but  this  should  be  left  to  the  dentist 
to  decide. 

FILLING  CHILDREN'S  TEETH.— Children's  teetn 
should  be  examined  at  regular  intervals — at  least 
twice  a  year,  sometimes  oftener — and  any  small  de- 
cayed place  should  be  cleaned  out  and  filled.  If  this  is 
commenced  early  the  child  will  not  mind  the  little 
work  necessary  to  properly  fill  the  tooth  and  prevent 
further  decay.  When  this  is  done  early  the  child  is  not 
hurt  by  the  dentist,  and  consequently  is  not  afraid  to 
come  back  at  another  time  and  have  more  teeth  filled. 
Perhaps  the  dentist  is  able  to  ''make  up"  with  his  little 
patient,  and  by  ''jolly  talk"  make  this  first  visit  to  the 
dentist  a  pleasure.  If  this  is  done  the  little  patient  will 
have  had  a  "nice  time"  at  the  dentist's,  and  when  it 
comes  time  to  return  for  another  examination,  will 
be  ready  and  willing  to  return  and  have  more  work 
done  if  it  is  necessary.    In  order  that  children  may  be 

—33— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

willing  to  visit  the  dentist  -it  is  necessary  that  parents 
and  others  use  a  little  common  sense  in  their  talk  be- 
fore the  little  ones.  NEVER  tell  a  child  that  he  will 
be  hurt  if  he  goes  to  the  dentist.  This  instills  a  dread 
of  the  dentist  in  the  child's  mind,  and  may  make  it 
difficult  or  impossible  to  get  him  to  the  dentist's  office. 

If  taken  there,  he  may  be  so  frightened  that  it  is 
impossible  for  the  dentist  to  render  any  service  to  him, 
or  even  to  make  an  examination  to  see  what  needs  to 
be  done,  or  to  give  him  proper  relief,  if  he  is  suffering 
pain  from  neglected  teeth. 

If  there  should  be  pain  given  when  attending  the 
little  patient,  let  the  dentist  alone.  He  will  usually  be 
able  to  gain  the  patient's  confidence,  and  if  he  hurts- 
the  child,  he  will  usually  be  forgiven  by  his  patient, 
provided  the  child  has  not  been  frightened  beforehand. 

Therefore,  '*grown-ups"  should  refrain  from  talking 
of  their  dental  experiences  before  children.  If  the 
child  has  not  been  told  things  and  frightened,  he 
usually  becomes  a  pliant  and  willing  patient  at  the 
hands  of  a  careful  and  friendly  dentist. 

On  the  other  hand,  take  the  child  who  has  had  its 
teeth  neglected,  and  has  teeth  that  ache  badly,  perhaps 
decayed  so  far  that  abscesses  or  '*gum-boils"  have 
form.ed.  He  has  been  told  how  it  ''hurts  to  go  to  the 
dentist".  He  has  suffered  all  night  or  day  with  the 
worst  kind  of  toothache,  frightened  so  that  toothache 
is  endured  rather  than  go  to  the  dentist.  Finally  the 
parents,  in  desperation,  having  been  kept  up  all  night 
by  a  suffering  child,  take  him  to  the  dentist.  Perhaps- 

—34— 


THE    TEMPORARY   TEETH 

the  child  is  forced  to  go,  carried  into  the  office,  crying 
and  resisting.  How  much  chance  has  any  dentist  to  get 
the  confidence  and  attention  of  this  child,  and  render 
him  any  service? 

Usually,  if  anything  is  accomplished,  it  is  because 
the  child  is  held  down  while  the  dentist  pulls  open  the 
mouth  and  extracts  an  aching  tooth,  while  the  patient 
protests  with  cries  and  struggles. 

Yes,  the  tooth  was  extracted,  but  was  not  something 
else  extracted  along  with  the  tooth?  The  confidence 
and  good-will  of  the  child,  and  perhaps  of  the  parents 
also,  and  a  fear  instilled  into  the  child's  mind  that 
will  prevent  a  return  to  the  dentist,  perhaps  for  many 
years  to  come,  or  until  prolonged  suffering  compels  a 
return  to  get  relief  from  pain  which  can  no  longer  be 
endured.  Is  it  any  wonder  that  many  dentists  dislike 
to  work  for  children  under  these  circumstances? 
Children  who  have  been  spoiled  at  home,  or  have  been 
taught  to  look  with  fear  upon  a  visit  to  the  dentist,  are 
usually  hopeless  as  patients.  And  how  about  the  den- 
tist, who,  from  a  sense  of  duty,  has  struggled  through  a 
fruitless  appointment  with  such  a  patient  ?  Often  after 
such  a  scene,  he  is  ready  to  close  up  his  office  and  go 
fishing,  or  somewhere  else  to  forget  his  troubles. 

Then  the  story  that  this  patient  can  tell  to  other 
children  may  prevent  many  other  little  patients  from 
making  a  much  needed  visit  to  the  dentist.  All  this  fear 
can  be  avoided  if  the  mother  will  give  a  little  time  and 
care  to  cleaning  her  baby's  teeth,  and  see  that  they 
are  kept  clean. 

—35— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

Frequent  examination  will  prevent  decay  getting  a 
start,  and  should  there  be  a  small  decayed  place  it  can 
easily  be  filled,  and  filled  without  pain,  and  without 
fear  of  being  hurt,  on  the  part  of  the  child. 

Refrain  from  talk  of  pain  before  the  child  and  there 
will  be  no  fear  in  visiting  the  dentist.  This  co-opera- 
tion, on  the  part  of  the  parents  and  the  ''grown-ups," 
with  the  efforts  of  a  careful  dentist,  will  do  much  to 
promote  the  good  health  of  the  growing  child,  insure 
a  good  set  of  teeth  to  masticate  the  food,  and  thus  pro- 
mote proper  digestion.  For  a  good  digestive  system  is 
required  in  order  that  the  child  may  develop  in  a. 
healthy  and  normal  way. 

HABITS. — While  the  mother  should  use  great  care 
in  keeping  her  baby's  teeth  clean,  she  should  also 
watch  and  guard  him  against  bad  habits,  which  many 
children  acquire  in  early  life,  and  which  may  result 
in  deformity  of  the  teeth,  and  even  of  the  face. 

SUCKING  THUMB  OR  FINGER.— This  is  a  very 
common  habit  of  infants,  and  during  the  first  few 
months  it  is  seen  to  some  degree  in  most  of  them.  If 
they  are  carefully  watched,  the  habit  is  easily  stopped. 
If  the  mother  or  nurse  is  careless,  the  habit  may  con- 
tinue indefinitely.  Young  infants  usually  suck  the 
finger  when  hungry,  and  while  this  may  seem  natural, 
it  should  be  prevented,  lest  the  habit  become  a  regular 
one.  The  feeding  time  of  the  infant  should  be  so  regu- 
lated that  it  never  gets  hungry. 

Two  forms  of  sucking  are  of  interest,  from  a  dental 
standpoint.  Sucking  of  the  thumb  or  finger,  and  suck- 

—36— 


THE    TEMPORARY    TEETH 

ing  or  nursing  the  lip.  In  thumb  sucking,  pressure  is 
made  on  the  lower  teeth,  causing  them  to  be  crowded 
inward,  while  the  upper  teeth  are  forced  outward. 
The  tissues  of  the  infant  are  very  tender,  and  a  little 
pressure  will  soon  make  a  change  in  the  form  of  the 
mouth.  Lip  sucking  causes  the  same  effect.  The  lower 
teeth  being  pressed  inward,  causes  a  contracted  lower 
arch,  which  will  lessen  the  room  for  the  permanent 
teeth,  if  the  habit  be  persisted  in  until  the  permanent 
teeth  appear.  If  not  prevented  before  the  permanent 
teeth  appear,  the  result  will  be  disfiguring.  The  teeth, 
will  be  irregular,  and  speech  and  mastication  will  be 
impaired.  The  result  of  finger  sucking  may  be  serious 
deformity  of  the  mouth,  and  finger  also.  Deformities 
of  the  teeth,  lips,  and  even  the  jaws,  are  sometimes, 
produced.  Habitual  sucking  of  one  hand  or  finger  may" 
lead  to  spinal  curvature.  Babies  sucking  the  thumb,, 
often  bend  the  body  sidewise,  in  their  efforts  to  keep 
the  thumb  in  the  mouth.  If  persisted  in,  sometimes 
the  spine  is  curved  to  one  side,  besides  causing  de- 
formity of  the  mouth.  These  cases  are  best  managed 
by  the  early  arrest  of  the  habit  before  it  becomes 
fixed.  Very  often  the  thumb  sucking  is  encouraged  by 
the  mother  or  nurse,  to  induce  a  temporary  quiet  in 
the  child  when  it  is  restless.  This  should  not  be  done 
under  any  circumstances.  Find  out  the  cause  of  the 
child's  restlessness,  and  remedy  that  cause,  and  there 
will  be  no  need  of  thumb  sucking  or  the  use  of  a, 
"pacifier." 

Once  the  habit  is  formed,  the  only  successful  treat— 

—37— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

ment  with  infants  is  mechanical  restraint.  Bitter  solu- 
tions on  the  fingers  are  useless.  They  are  soon  sucked 
off  and  the  habit  continues.  With  infants  the  hands 
may  be  covered  with  mittens,  or  with  the  long  sleeves 
of  the  night-gown,  which  are  pinned  to  the  bed,  so  that 
the  part  sucked  cannot  be  put  into  the  mouth.  Or  a 
splint  may  be  made  to  fit  the  elbow,  so  that  the  arm 
cannot  be  bent  and  allow  the  fingers  near  the  mouth. 
In  mild  cases  the  habit  may  be  voluntarily  discontin- 
ued, but  when  indulged  in  until  the  child  is  four  or 
five  years  old,  it  has  become  a  chronic  affair  and 
difficult  to  stop. 

As  a  rule,  punishment  does  not  avail  in  the  late 
■cases.  Sometimes  a  child  may  be  shamed  into  quitting 
the  habit,  but  more  often  rewards  are  more  successful. 
Xip  sucking  may  be  difficult  to  prevent.  This  habit  is 
Tisually  formed  in  connection  with  thumb  sucking. 
Lip  sucking  seldom  becomes  a  permanent  habit, 
although  a  case  presents  now  and  then  that  persists. 

MOUTH   BREATHING.— The   habit   of   breathing 
through  the  mouth  will,  if  persisted  in,  lead  to  a  nar- 
rowing of  the  upper  arch,  and  cause  the  mouth  to  be 
deformed  and  the  teeth  to  be  irregular.     This  habit, 
is     nearly     always     due     to     obstructions     in     the 
nasal     passages.       These     obstructions     are     gener- 
:.ally   adenoid   vegetations   of   the   vault   of   the   naso- 
pharynx,   and    are   the    source   of    much    discomfort, 
and  the  origin  of  more  minor  ailments  than  any  other 
pathological  condition  of  childhood.     Growths,  large 
enough  to  produce  pronounced  nasal  obstructions,  will 

—38— 


THE    TEMPORARY   TEETH 

cause  changes  in  the  facial  bones,  causing  a  V  shaped 
arch  and  irregularity  of  the  teeth,  such  as  illustrated 
in  the  figure  below. 


Deformities 
of  the  thorax 
will  be  caused 
if  the  breath- 
ing conditions 
are  not  cor- 
rected. The 
symptoms  o  f 
adenoid 
growths  are 
usually  no- 
ticed in  child- 
ren    from     a 


Figure  lY.   Model   of  a   girl's   mouth,   age 
nine  years,  showing  irregular  teeth. 


year  and  a  half  old  to  three  years  old,  the  symptoms 
increasing  in  severity  with  advance  of  age  up  to  the 
sixth  or  seventh  year,  the  conditions  being  better  in 
summer,  and  v»^orse  in  winter,  when  weather  condi- 
tions are  worse  in  the  temperate  zones. 

The  chief  symptoms  are  chronic  catarrh,  nasal  ob- 
structions, deafness,  anemia,  and  nervous  disturb- 
ances. 

The  obstructive  symptomis  are  of  chief  interest  from 
a  dental  standpoint,  because,  by  this  condition,  the 
mouth  breathing  is  induced.  The  child  being  unable 
to  breathe  freely  through  the  nose,  forms  the  habit 
of  breathing  through  the  mouth.     The  mouth  being 

—39— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

held  open,  draws  the  strong  muscles  of  the  side  of  the 
face  against  the  upper  arch  and  teeth,  and  causes  con- 
stant pressure  there,  which  tends  to  make  the  arch 
narrow  and  of  a  V  shape.  Obstructions  of  the  nasal 
passages  cause  the  child  to  sleep  in  all  kinds  of  posi- 
tions, in  an  endeavor  to  find  some  position  in  which 
breathing  may  be  easy.  These  attacks  of  difficult 
breathing  are  doubtless  often  the  explanation  of  many 
of  the  night-terrors  from  which  many  children  suffer. 

Sometimes  it  is  possible  that  the  adenoid  growths 
may  disappear  by  absorption,  but  this  will  occur  only 
when  the  growths  are  very  small.  The  physician  may 
assist  by  treating  the  growths,  or  the  patient  may  be 
removed  to  a  warm,  dry  climate  during  the  wiiiter 
season. 

Removal  of  adenoid  growths  is  necessary  when  they 
cause  mouth  breathing,  disturbed  sleep,  or  nasal 
discharges.  The  family  physician  should  be  consulted 
and  his  advice  followed.  If  the  parent  will  form  the 
habit  of  having  the  child's  teeth  examined  at  regular 
intervals,  many  early  oral  conditions  will  be  discov- 
ered and  treated  before  they  become  serious. 

A  child  two  or  three  years  old  is  not  too  young  to 
have  regular  appointments  witb  the  dentist.  Thus, 
early  decay  may  be  attended  to,  and  if  enlarged  ton- 
sils or  adenoid  growths  are  present,  they  will  be  no- 
ticed by  the  dentist,  and  the  attention  of  the  parent 
called  to  the  condition,  and  an  early  viijit  to  the  physi- 
cian can  be  made,  thus  avoiding  more  serious  trouble. 

CRACKING  NUTS.— The  teeth  and  bones  of  child- 

—40— 


THE    TEMPORARY    TEETH 

ren  in  early  life  are  not  as  strong  as  they  are 
in  later  life.  The  child's  teeth  are  small  and  frail,  and 
should  not  be  used  as  nut  crackers.  Cracking  nuts  will 
soon  result  in  their  destruction,  for  they  are  not  con- 
structed to  stand  such  violent  service.  When  the  child 
is  old  enough  to  eat  nuts,  he  should  be  taught  never  to 
use  his  teeth  on  such  hard  objects  as  nut  shells. 

EATING  CANDY.— Most  children  crave  sweets, 
and  most  of  them  get  more  or  less  candy.  Good,  clean 
candy  will  do  no  harm  to  the  teeth,  if  eaten  in  moder- 
ation, and  the  teeth  are  properly  brushed  and  cleaned 
after  eating  the  candy.  Hard  candies  should  never  be 
eaten,  for  they  may  cause  the  teeth  to  be  broken^ 
Under  our  pure  food  laws,  less  adulterated  candy  is- 
sold  than  formerly,  yet  the  parent  will  do  well  to  see 
that  only  good,  clean  candy  is  used  by  the  child. 

In  former  years  cheap  candies  were  frequently 
mixed  with  acid,  and  arsenic  used  as  coloring  matter. 
Such  candy  is  very  destructive  to  the  teeth  of  the 
growing  child. 

EATING  HABITS.— Children  should  be  taught  tO' 
eat  their  food  slowly,  chewing  it  well  before  swallow- 
ing. They  should  also  be  taught  not  to  eat  food  that  is. 
very  hot.  Sometimes  a  child  will  eat  food  that  is  hot 
and  immediately  take  a  drink  of  cold  water^  perhaps 
ice-water.  This  combination  of  hot  and  cold  on  the 
teeth  is  very  injurious  to  them,  and  also  to  the 
stomach.  The  food  should  contain  a  generous  supply 
of  tooth  building  materials.  Too  much  fine  white 
flour  bread,  sugar  and  pastries,  are  not  good  for  the 

—41— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

child.  The  food  should  be  plain  and  substantial,  not 
too  fat  or  too  rich. 

SUMMARY. — As  soon  as  the  temporary  teeth 
appear,  great  care  should  be  taken  to  keep  them  clean. 
Twice  a  year  the  teeth  should  be  examined  by  the 
dentist,  and  any  small  decayed  place  cleaned  out  and 
filled.  The  child  should  not  have  any  of  the  temporary 
teeth  extracted  but  should  preserve  them  until  the 
time  for  the  permanent  teeth  to  erupt.  Sound  tem- 
porary teeth  are  the  foundation  for  sound  permanent 
teeth.  By  proper  care  of  the  first  set  of  teeth,  the 
mother  may  be  assured  that  her  child  will  have  a  set 
of  sound  permanent  teeth,  which  with  proper  care  will 
last  for  his  life-time,  and  do  much  toward  building  up 
a  good,  sound  physical  condition,  which  is  essential  to 
the  proper  development  of  the  child,  mentally  and 
morally,  as  well  as  physically. 


42  — 


CHILDREN'S  TEETH. 

CHAPTER  III. 

By  the  end  of  the  second  year,  the  child  has  the  com- 
plete set  of  temporary  or  milk  teeth,  twenty  in  num- 
ber, ten  below  and  ten  above.  Now  there  follows  a 
pause  of  about  four  years,  during  which  time  little 
perceptible  change  takes  place  in  the  mouth.  How- 
ever, there  is  an  active  change  going  on  beneath  the 
gums ;  a  further  development  for  the  production  of  the 
adult  conditions.  ABOUT  THE  SIXTH  YEAR  FOUR 
NEW  TEETH  APPEAR.  THESE  ARE  THE  FIRST 
PERMANENT   MOLARS,    ONE    ON   EACH   SIDE,. 


Figure  V.  A  lower  set  of  teeth,  showing  tlie  first 
jjermanent  molars  in  place,  which  come  in  at  six 
years  of  age.  The  two  central  incisors  in  front  are 
permanent  teeth,  and  come  in  at  seven  years  of  age.. 
Courtesv,  Blue  Island  Specialty  Co. 

—43—^ 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

I    ABOVE  AND  BELOW,  JUST  BEHIND  THE  SET 
'  OF  MILK  TEETH. 

Heretofore  the  mother  has  been  able  to  count  only 

ten  teeth  in  each  jaw.    Now  there  are  twelve.    So  the 

child^  will   have   in  all,  twenty-four  teeth.     This  is  a 
most  critical  period  in  the  dental  life  of  the  child.    If 

the  temporary  teeth  have  been  well  cared  for,  and  are 
I  clean  and  free  from  decay,  then  the  new  teeth  will  be  in 

'  a  favorable  environment,  and  not  exposed  to  decay.  By 

'         proper  attention  these  new  teeth  need  never  decay. 

Let    us    suppose    that    the    temporary    teeth    have 

not  received  good  care,  between  the  ages  of  two  and 

six  years,  when  the  first  permanent  molars  appear. 
I  The  temporary  teeth  will  have  large  decayed  places, 

I         and  perhaps  the  pulps  of  some  of  the  teeth  have  died, 

and  caused  abscesses  or  ''gum-boils"  to  form.  The  teeth 
\         will  contain  decay,  and  some  of  it  will  naturally  float 

around  and  become  lodged  on  the  new  teeth,  and  before 
f  very  long  these  new  teeth  will   commence  to  decay. 

i  These  six  year  molars  should  have  special  attention, 

for  they  are  often  confused  with  the  temporary  set  of 

teeth,  and  the  parent  allows  the  decay  to  go  on  until  the 
I  teeth  ache,  and  perhaps  have  to  be  taken  out.  The 
I  reason  for  this  confusion  is  that  these  six  year  molars 
f  make  their  appearance  before  any  of  the  temporary 
[         teeth  are  shed. 

f  When  eleven  or  twelve  teeth  can  be  counted  in  each 

j         jaw,  that  is,  as  soon  as  there  are  more  than  twenty 
j         teeth  in  all,  one  can  be  assured  that  the  last  molars 

on  each  side  belong  to  the  permanent  set. 

:  —44—  : 


CHILDREN'S   TEETH 

The  following  table  will  show  the  average  age  at 
which  the  milk  teeth  are  shed: 

*  Central  Incisors Seventh  Year. 

Lateral  Incisors   Eighth  year. 

First  Molars    Tenth  year. 

Cuspids Twelfth  year. 

Second  Molars  .  .  Eleventh  to  Twelfth  year. 
As  soon  as  the  temporary  teeth  are  shed,  the  crowns 
of   the   permanent   teeth    begin    to    push   their    way 
through  the  gums,  and  make  their  appearance  in  the 
following  order: 

PERMANENT  TEETH. 
*First  Molars .  .  Five  and  a  half  to  Seven  years. 

Central  Incisors Seven  to  Eight  years. 

Lateral  Incisors Eight  to  Nine  years. 

First  Bicuspids Ten  to  Eleven  years. 

Second  Bicuspids ....  Eleven  to  Twelve  years. 

Cuspids,    the  lotver  usually  preceding   by  a 

year  or  more  .  .  .  .Twelve  to  Fourteen  years. 

Second  Molars.  .  .  .Twelve  to  Fourteen  years. 

Third  Molars.  .Sixteen  to  Twenty  years  and 

indefinitely  beyond. 
Most  parents  look  upon  any  special  care  of  the 
temporary  teeth  as  useless,  since  they  believe  that 
these  teeth  are  to  last  only  a  little  while.  This  is  due 
to  an  utter  lack  of  appreciation  of  the  purpose  of  the 
temporary  set  of  teeth.  Each  adult  person  is  provided 
with  two  sets  of  teeth,  which  make  their  appearance 
at  different  periods  of  life.    The  child,  being  small,  is 

"^Burcharcl's  Dental  Pathologv. 

—45— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

provided  with  a  set  of  small  teeth.  As  these  teeth 
themselves  cannot  increase  in  size  to  keep  up  with  the 
growing  maxillae  (jaws),  this  small  set  is  gradually 
replaced  by  a  larger  and  stronger  set  of  teeth,  in  pro- 
portion to  the  stronger  and  larger  jaws.  If  this 
replacement  takes  place  in  a  normal  manner,  the  child 
will  be  provided  with  a  continuous  masticating  ap- 
paratus. This  temporary  set  is,  therefore,  intended  to 
perform  the  work  of  their  permanent  successors  until 
replaced  by  the  latter. 

If  the  temporary  teeth  are  properly  taken  care  of, 
the  replacement  of  the  temporary  teeth  goes  on  with- 
out any  trouble;   but  if  any  of  these  are  lost  pre- 
maturely, or  are  destroyed  by  decay,  and  abscesses  are 
allowed   to  form   from   dead  pulps,  then  things  have 
gone  wrong,  and  the  child  suffers,  not  only  the  tempor- 
ary pain  from  aching  teeth,  but  may  also  suffer  in  later 
life  from  conditions  caused  by  early  dental  troubles. 
One  such  condition  is  infected  tonsils,  from  the  pus  of 
abscessed  teeth.  This  often  causes  throat  and  ear  infec- 
tion, which,  if  not  properly  treated,  will  in  later  life  re- 
sult in  partial  deafness,  or  in  extreme  cases,  in  total 
deafness. 

Should  it  become  necessary  to  extract  decayed  and 
abscessed  teeth,  the  second  teeth  will  often  not  erupt,, 
or  come  in,  properly,  and  will  grow  out  of  their  re- 
gular places.  The  mouth  will  be  distorted,  and  the 
work  of  mastication  be  impaired.  Should  the  child 
also  have  adenoids,  he  will  become  a  mouth  breather,, 
and  this  often  results  in  defective  breathing. 

—46— 


CHILDREN'S  TEETH 

Such  cases  are  a  familiar  sight  in  every  school.  Such 
:a  child  is  stoop-shouldered,  listless,  dull  mentally,  and 
below  the  average  in  school  work.  Sometimes  such  re-, 
suits  make  the  child  vicious  and  incorrigible.  Often 
the  removal  of  the  adenoid  growths,  and  proper  dental 
attention,  will  make  a  new  child  out  of  the  dull,  list- 
less, or  vicious  one.  He  becomes  more  alert,  and  more 
orderly  in  work  and  conduct. 

BOLTING  FOOD.— Teeth  which  have  decay  in 
them  are  generally  sensitive  when  used  to  masticate 
the  food.  If  part  of  the  teeth  have  been  extracted,  and 
some  of  them  are  tender,  the  food  is  not  properly  cut 
up  and  mixed  with  saliva.  This  causes  the  child  to  "bolt 
its  food",  namely,  to  swallow  it  before  it  is  properly 
masticated  and  mixed  with  saliva.  Thus  bad  eating 
habits  are  established  early  in  life,  which  may  affect 
the  health  of  the  growing  child,  and  affect  him  even  in 
later  life. 

In  the  first  chapter,  a  brief  outline  has  been  given  of 
the  digestive  system.  The  effects  of  diseased  teeth 
fall,  in  the  first  place,  on  the  whole  of  the  alimentary 
tract,  from  the  tonsils  downward.  The  effects  include 
tonsilitis,  pharyngitis,  gastric  troubles,  and  other 
troubles  in  adjacent  parts,  an  example  of  which  is 
appendicitis,  the  origin  of  which  may  be  the  chronic 
abscesses  or  "gum  boils"  of  childhood.  The  germs  of 
these  diseases  lodge  in  the  decayed  places  of  the  teeth, 
and  may  later  be  absorbed  into  the  body. 

Consider  for  a  m.oment  the  effect  of  this  daily  'dose 
of  poison"  upon  the  system  of  the  growing  child.    This 

—47— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

infected  material,  constantly  being  conveyed  to  the 
tonsils  and  throat,  must  be  taken  care  of  some  way. 
Much  of  it  is  swallowed,  and  some  of  it  infecting  the 
tonsils  and  throat.  The  up-to-date  surgeon,  when  a  pa- 
tient requires  an  operation  for  appendicitis,  examines, 
the  throat  for  infected  tonsils,  especially  if  the  patient 
is  a  young  person.  He  does  this  because  experience 
teaches  him  that  most  of  the  appendix  cases  have 
diseased  tonsils,  and  these  have  probably  become  in- 
fected in  early  youth,  from  neglected  teeth.  Thus  the 
effect  of  diseased  teeth  should  not  be  underestimated^ 
as  they  vitally  affect  the  normal  development  of  the 
child;  and  we  know  that  among  the  great  army  of 
children  with  neglected  and  diseased  mouths,  there  is 
in  all  of  them  an  incredible  amount  of  infection  and 
fermentation.  The  effect  of  harboring  this  poison  is 
that  the  glands  in  and  near  the  oral  cavity  are  in- 
fected. Absorption  takes  place  from  these  infected 
areas,  and  the  influence  of  this  is  felt,  not  only  in  the 
neighboring  glands,  but  also  results  in  a  group  of  con- 
ditions which  might  be  referred  to  as  anemic,  or  a 
low  state  of  vitality. 

To  avoid  such  conditions,  we  should  start  the  child 
out  in  life  with  a  clean  mouth,  and  as  soon  as  he  is  old 
enough  to  learn,  he  should  be  taught  to  keep  his  mouth 
clean. 

Children  are  responsive  to  the  delicious  sensation 
produced  by  a  clean  mouth,  as  are  older  people,  and  if 
the  child's  mouth  is  kept  clean  during  the  time  that 
duty  should  be  performed  by  the  mother  or  nurse,  the 

—48— 


CHILDREN'S   TEETH 

habit  of  having  a  clean  mouth  will  be  formed  and  con- 
tinued by  him  without  much  coaxing.  If  the  child  has 
a  set  of  teeth  free  from  inherited  defects,  this  care  will 
preserve  them  until  they  are  replaced  by  the  per- 
manent ones.  Thus  the  permanent  teeth  will  come  in, 
and  be  in  good  clean  company,  and  will  not  be  exposed 
to  decay  from  other  infected  teeth. 

This  problem  is  an  important  one  for  the  dental  and 
the  medical  profession,  and  its  proper  solution  will  be 
in  the  interest  of  public  health,  and  particularly  of  our 
school  children.  From  thirty  to  fifty  percent  suffer 
from  dental  and  oral  sepsis  and  their  after-defects. 
Further,  about  seventy  to  ninety  percent  need  some 
dental  attention  to  avert  the  more  severe  defects. 

FILLING  CHILDREN'S  TEETH.— Unfortunately 
few  children  are  given  this  care  to  insure  them  a  clean 
mouth  and  good  teeth.  Few  mothers  have  the  incli- 
nation or  a  proper  conception  of  the  importance  of 
such  service  to  their  little  ones.  Thus  it  happens  that 
the  first  view  the  dentist  has  of  the  average 
child's  mouth,  brought  to  him  for  attention,  is  rather 
discouraging.  A  large  majority  of  parents  have  never 
thought  it  necessary  to  clean  their  children's  teeth,  or 
to  teach  them  to  do  so  themselves,  as  they  grow  up. 
The  problem  for  the  dentist  here  is,  first  to  relieve  the 
present  pain,  and  later  to  get  the  mouth  of  the  little 
patient  in  a  healthy  condition.  When  such  cases  come 
to  the  dentist  for  the  first  time,  the  usual  request  i& 
that  he  extract  the  tooth.  Before  extracting  an 
aching  tooth,  would  it  not  be  better  to  see  if  the  tooth 

—49— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

could  be  saved  and  made  useful?  This  may  not  be 
possible,  if  it  is  badly  decayed,  and  broken  down,  and 
has  an  abscess  or  "gum-boil"  developed  on  the  gum.  No 
doubt  if  the  destructive  work  has  reached  this  stage,  it 
will  be  well  to  extract  the  tooth,  and  remove  this 
source  of  infection  from  the  throat  and  tonsils. 
Perhaps  the  toothache  has  been  caused  only  by  a 
simple  decayed  place,  in  which  some  food,  or  candy, 
has  lodged.  In  this  case  it  will  be  far  better  to  treat 
the  tooth,  relieving  the  present  pain,  and  permit  the 
little  patient  to  return  at  another  time  and  have  the 
tooth  filled.  To  extract  the  tooth  will  destroy  the  reg- 
ularity of  the  temporary  set  of  teeth,  and  perhaps  of 
the  second  set  also.  « 

Suppose  the  patient  had  a  sore  or  festered  finger, 
and  went  to  the  doctor  and  told  him  to  cut  it  off,  be- 
cause it  was  sore.  Do  you  think  that  the  doctor  would 
do  such  a  thing?  No.  He  would  say:  *'The  finger  is 
useful  to  the  child.  I  can  cure  the  sore  place,  and 
make  it  a  useful  finger." 

The  little  temporary  tooth,  that  has  a  hole  in  it 
and  aches,  was  put  into  the  mouth  for  a  useful  pur- 
pose, and  should  remain  there  until  nature  provides 
a  new  tooth  to  take  its  place.  It  is  useful,  and  can  be 
saved  if  filled  and  properly  taken  care  of. 

FILLING  TEETH.—  To  fill  any  tooth  properly, 
ALL  the  decay  should  be  removed  from  the  cavity. 
However,  in  children,  this  cannot  always  be  done,  and 
in  the  temporary  teeth  it  may  not  be  necessary.  If 
the  child  will  allow  enough  decay  to  be  scraped  out  so 

—50— 


CHILDREN'S  TEETH 

that  a  copper  cement  filling  can  be  inserted,  the  tooth 
can  be  repaired  and  made  useful. 

The  reason  copper  cement  is  used  in  children's  teeth, 
is  because  they  will  not  tolerate  having  all  of  the  decay 
removed.  The  copper  cement  is  very  sticky,  and  will  ad- 
here or  stick  in  shallow  cavities  where  no  other  material 
will.  It  is  a  germicide,  and  will  sterilize  what  little  decay 
is  left,  and  thus  arrest  the  further  progress  of  the  decay. 

The  copper  salts  contained  in  a  good  copper  cement 
sterilize  the  cavity,  while  the  body  of  the  cement  pre- 
vents contact  of  the  food  with  the  sensitive  part  of  the 
tooth. 

Objection  may  be  made  by  some  to  copper  cement, 
because  it  is  black.  This  is  not  to  be  considered 
first;  because  most  of  these  fillings  are  placed  in  the 
back  teeth,  and  do  not  show ;  and  second ;  the  results 
from  the  use  of  this  cement  are  better  than  that  of 
any  other  known  material.  However,  there  is  a  white 
copper  cement  that  can  be  used  if  the  filling  shows,  and 
that  objection  is  overcome  by  using  this  kind. 

Sometimes  in  removing  the  decay,  the  pulp,  or 
"nerve",  will  be  exposed.  Even  in  such  cases  these 
temporary  teeth  can  be  treated,  the  pulp  removed,  the 
root  canals  filled,  and  a  filling  made  to  restore  the 
crown  of  the  tooth.  Children  from  six  to  ten  years  old 
will  usually  allow  such  work  to  be  done. 

If  the  cavity  is  in  a  front  tooth,  and  a  small  one, 
enamel  cement  can  be  used.  This  is  a  hard  cement, 
and  much  resembles  the  enamel  of  the  teeth.  It  comes 
in  various  shades  or  colors  to  match  different  shades 

—51— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

of  teeth,  and  restores  the  teeth  to  their  normal  appear- 
ance.   It  is  sometimes  called  artificial  enamel. 

If  the  front  teeth  are  very  badly  decayed,  some 
other  way  must  be  found  to  restore  them  to  usefulness. 
If  the  pulps  are  not  forming  abscesses,  the  tooth  can 
often  be  trimmed  down  a  little,  and  a  small  gold  jack- 
et of  very  thin  gold  can  be  molded  over  the  tooth,  and 
after  soldering  the  joints  together,  this  jacket  or 
crown  can  be  cemented  over  the  tooth  with  white  cop- 
per cement,  and  the  tooth  preserved  and  made  useful, 
until  the  time  it  should  come  out  and  be  replaced  by 
the  permanent  one. 

FILLING  THE  FIRST  PERMANENT  MOLARS.— 
Due  to  the  fact  that  the  first  permanent  molars  eru^t 
before  any  of  the  temporary  teeth  are  shed,  they  are 
often  confused  with  the  temporary  teeth,  and  are 
allowed  to  decay.  Often  the  dentist  does  not  see  the 
young  patient  until  decaj^  has  done  considerable  dam- 
age to  these  permanent  teeth.  The  child  complains  of 
a  toothache,  and  often  requests  are  made  by  the  par- 
ents that  the  tooth  be  extracted.  The  first  permanent 
molar  should  be  retained,  if  it  is  at  all  possible. 
The  age  of  the  child,  and  the  extent  of  the  decay,  will 
have  a  great  deal  to  do  with  the  case.  The  roots  of 
these  teeth  are  usually  formed  by  the  end  of  the 
tenth  year,  but  should  the  pulp  be  exposed,  it  may  be 
difficult  or  impossible  to  treat  such  a  tooth,  because 
the  opening  at  the  end  of  the  root  is  overlarge  at  this 
time. 

Twelve  years  is  a  safer  age  for  root  treatment,  as 

—52— 


CHILDREN'S  TEETft 

the  openings  are  usually  closed  properly  at  that 
time.  If  the  pulp  is  exposed,  an  effort  should  be  made 
to  treat  the  tooth  and  plug  the  root  canals,  after  which 
a  filling  may  be  placed  in  the  crown  of  the  tooth,  and 
the  tooth  will  then  become  useful.  Should  the  tooth 
have  to  be  extracted,  there  would  be  an  open  space  left 
which  would  impede  mastication.  If  several  teeth 
were  lost,  the  child  would  be  unable  to  chew  his  food 
properly,  and  would  learn  bad  habits  of  mastication. 
The  food  would  be  ''bolted",  namely,  swallowed,  with- 
out being  properly  chewed  and  mixed  with  saliva.  This 
throws  extra  work  upon  the  stomach,  and  interferes 
with  the  progress  of  digestion,  which  is  bad  for  the 
health  of  the  growing  child. 

But  many  of  these  teeth  can  be  filled  without  treat- 
ing them.  Usually  the  decay  can  be  removed  with  a 
Iiand  instrument.  If  the  cavity  is  large,  a  copper 
cement  filling  can  be  made  to  protect  the  tooth.  It  will 
last  for  a  year  a  two,  and  can  be  replaced  if  it  comes 
out;  or  a  permanent  ''silver"  filling  can  be  inserted,  as 
soon  as  the  child  is  a  little  older  and  will  allow  all  the 
decay  to  be  removed. 

Often  the  cavity  is  small,  and  all  the  decay  can  be 
removed  the  first  time.  In  that  case  a  permanent  "sil- 
ver" filling  may  be  inserted  at  once,  and  the  tooth  made 
safe.  If  the  child  is  sent  to  the  dentist  from  the  time 
he  is  three  or  four  years  old,  and  makes  a  practice  of 
having  the  teeth  examined  twice  a  year,  decay  will 
be  controlled.  Should  little  cavities  form,  they  are 
easily  taken  care  of,  and  can  be  filled  without  pain  to 

—53— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

the  patient.  If  at  the  same  time  proper  instruction  be 
given  in  the  care  of  cleaning  the  teeth,  and  the  parents 
see  to  it  that  the  instructions  are  carried  out,  the  child 
will  have  a  clean  mouth,  clean  teeth,  and  will  not  be 
troubled  with  toothache  from  decayed  teeth.  Clean 
teeth  do  not  decay. 


54— 


ORAL  HYGIENE,  AND  DENTAL  AND  MEDICAL 
EXAMINATION  OF  SCHOOL  CHILDREN. 

CHAPTER  IV. 

The  trend  of  all  modern  health  work  is  in  the  direc- 
tion of  prevention.  To  cure  disease  is  a  great  achieve- 
ment, but  to  prevent  it  is  a  greater.  Every  year  the 
people  of  this  country  are  taking  more  interest  along 
educational  lines,  and  dental  education  is  making  great 
progress,  wherever  dental  publicity  is  encouraged 
through  dental  societies. 

Newspapers  and  magazines  realize  and  acknowledge 
their  mission  in  promoting  health  clubs,  giving  pub- 
licity to  mouth  hygiene  work  and  the  teachings  set 
forth  by  the  dental  and  medical  professions.  We  spend 
each  year  millions  of  dollars  for  education.  The  young 
men  and  women  who  graduate  from  our  public  schools 
and  colleges  are  a  credit  to  the  nation. 

We  do  not  graduate  enough  of  the  boys  and  girls 
who  enter  our  schools.  Many  of  them  attend  for  a  few 
years,  and  as  soon  as  they  reach  the  age  of  school  ex- 
emption, quit  and  hunt  a  job,  or  become  idlers.  There 
may  be  some  excuse  for  the  boy  who  quits  school  to 
support  a  widowed  mother,  or  to  care  for  little  broth- 
ers and  sisters.  But  there  is  another  class  of  boys  who 
do  not  have  this  excuse.  They  quit  school  as  soon  as 
they  pass  the  age  when  they  do  not  have  to  avoid  the 
truant  officer  and  these  are  the  ones  who  give  the  most 
trouble.  While  in  school  they  are  indifferent  pupils,' 
absent  themselves  whenever  they  have  an  opportunity, 

—55— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

are  backward  in  their  studies,  often  in  trouble  with 
their  teachers,  always  restless,  and  many  develop 
vicious  habits. 

There  must  be  a  reason  why  these  pupils,  both  boys 
and  girls,  resent  the  confinement  and  discipline  of 
school.  Normal  children  go  to  school,  study,  adapt 
themselves  to  discipline,  and  complete  the  school 
course;  while  they  may  be  inclined  to  mischief  at 
times,  they  are  usually  model  pupils.  If  a  pupil  is  rest- 
less, backward  in  classes,  often  absent  from  sessions, 
or  develops  habits  or  an  attitude  of  mind  that  pre- 
vents good  school  work,  it  will  usually  be  found  that 
such  a  pupil  is  defective  in  a  physical  way.  Dental 
and  medical  examinations  of  our  school  children  will 
discover  these  defects,  and  allow  of  most  of  them  be- 
ing corrected  before  serious  harm  is  done.  Wherever 
dental  examinations  have  been  conducted  by  dentists, 
the  statistics  show  about  ninety-five  percent  of  the 
children's  mouths  contain  defective  teeth.  This  may 
seem  an  exaggeration,  but  let  anyone  who  is  skeptical, 
examine  the  mouths  of  a  few  school  children,  between 
the  ages  of  seven  and  fifteen,  and  the  conditions  found 
will  soon  convince  him  of  the  truth  of  the  statement. 
It  is  an  acknowledged  fact,  by  both  the  medical  and 
dental  professions,  that  there  is  no  part  of  the  body  so 
closely  associated  with  general  health  conditions  as 
the  mouth.  It  has  been  said  that  the  mouth  is  the 
gateway  of  the  human  body.  This  being  true,  what 
must  be  the  effect  of  a  mouth  full  of  decaying  teeth, 
perhaps    abscesses    formed,    discharging   pus,    which 

—56— 


ORAL  HYGIENE,  DENTAL  AND  MEDICAL  EXAMINATION 

affects  the  tonsils,  nose  and  throat,  and  other  parts  of 
the  body?  Such  a  mouth  becomes  an  incubator  for 
disease  germs  that  may  be  carried  directly  into  the 
system. 

We  have  here  conditions  to  which  we  have  paid  little 
attention  in  the  past  years,  considering  them  of  minor 
importance.  But  of  late  they  have  been  recognized  as 
having  a  great  influence  on  the  development  of  the 
growing  child.  These  conditions  create  toxins,  or 
pathological  organisms,  which  are  constantly  absorbed, 
and  lower  the  vitality  of  the  body,  and  lay  the 
foundations  for  more  serious  troubles. 

If  the  child  is  not  taught  to  keep  his  mouth  clean, 
the  result  will  be  oral  sepsis,  which  will  soon  result 
in  dental  troubles;  then  follows  gastro-intestinal 
disturbances,  and  the  result  will  be  an  ill-nourished 
body.  The  systemic  disturbances  produced  will  lower 
the  bodily  resistance,  rendering  it  more  susceptible 
to  contractible  diseases. 

Children  are  congregated  in  the  school-room,  and 
spend  much  of  their  time  in  contact  with  each  other. 
Contagious  diseases  are  thus  easily  spread.  Many 
people  do  not  appreciate  the  fact  that  one  unclean 
mouth  may  contaminate  the  air  in  a  school-room,  and 
become  the  means  of  spreading  disease  to  other  child- 
ren. When  a  child  comes  to  school  with  dirty  hands 
and  face,  the  teacher  usually  takes  prompt  measures 
to  introduce  him  to  a  liberal  supply  of  soap,  water  and 
a  towel ;  which  results  in  at  least  an  outward  appear- 
ance of  cleanliness  for  that  particular  offender.    Most 

—57— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

of  our  states  have  laws  which  regulate  the  construc- 
tion of  public  school  buildings,  whereby  there  is  plenty 
of  light,  air  space,  and  a  proper  temperature. 

These  are  only  partial  measures.  The  majority 
receive  pupils  with  diseased  m^ouths,  infected  tonsils, 
many  with  inherited  defects,  and  other  disorders; 
and  also  children  who  may  have  been  exposed  to  in- 
fectious diseases  like  diphtheria,  mumps,  scarlet 
fever,  measles,  tonsilitis,  whooping-cough  or  chicken- 
pox.  These  children  mingle  with  their  playmates  for 
awhile  before  outward  signs  of  some  of  these  diseases 
make  their  appearance,  and  the  entire  school  is  thus 
exposed  to  the  infection.  If  the  state  finds  it  advis- 
able to  provide  clean,  sanitary  buildings  for  edu- 
cational purposes,  properly  lighted  and  ventilated, 
and  that  the  children  have  clean  hands,  faces  and 
clothing;  would  it  not  seem  reasonable  that  every 
child  should  also  be  required  to  have  a  clean  mouth, 
and  be  free  from  disease  which  endangers  his  own  and 
the  health  of  others  with  whom  he  is  so  closely  asso- 
ciated ? 

Dental  and  medical  inspection,  with  the  establish- 
ment of  free  dental  clinics  for  those  who  are  unable 
to  pay,  will  do  much  to  promote  public  health,  and 
especially  the  health  of  the  children  in  our  schools. 
Many  people  may  object  to  such  examinations, 
and  say  that  this  will  cost  more  money,  and  that  our 
taxes  are  already  high  enough,  without  adding  extra 
burdens.  Let  us  see  whether  this  is  true,  and  con- 
sider the  problem  from  a  business  standpoint.     If  a 

—58— 


ORAL  HYGIENE,  DENTAL  AND  MEDICAL  EXAMINATION 

business  man  wants  to  engage  in  any  enterprise,  his 
first  thought  is,  Will  it  pay?  Will  it  be  profitable? 
The  taxpayers  may  be  pardoned  if  they  are  skeptical 
at  first,  and  hesitate  to  encourage  such  work  in  the 
schools.  If  they  can  be  convinced  that  it  pays  they 
will  be  eager  to  encourage  the  work,  for  nothing  ap- 
peals more  to  the  average  business  man  than  some- 
thing that  will  conserve  his  pocket-book.  To  get  a 
proper  understanding  of  this  subject,  it  might  be  well 
to  give  facts  in  regard  to  dental  conditions  which  pre- 
vail in  our  public  schools,  their  retarding  effect  on 
the  pupils,  the  benefits  to  be  derived  by  preventing 
and  correcting  such  conditions;  also,  what  benefits 
are  to  be  derived  from  a  combined  dental  and  medical 
inspection  of  our  schools,  the  cost  of  this  service,  and 
the  ultimate  benefits  that  will  result  to  the  community 
at  large. 

DENTAL  CONDITIONS  IN  OUR  PUBLIC 
SCHOOLS. — The  need  of  dental  work  and  instruction 
in  oral  hygiene  among  the  public  school  children  is 
well  known  to  dentists,  and  those  who  have  been  en- 
gaged in  school  work,  but  is  not  so  well  known  to  the 
public  at  large. 

Cleveland,  Chicago,  Boston,  New  York,  and  other 
large  cities  have  conducted  dental  examinations  of 
school  children,  and  the  records  made  show  that  over 
ninety-five  percent  have  defective  teeth.  This  looks 
like  poor  dental  conditions,  and  it  really  is  poor.  It 
demonstrates  that  the  family  cannot  be  relied  upon 
to  prevent  these  conditions ;    therefore  the  school  and 

—59— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

family  should  co-operate,  and  teach  the  principles  of 
oral  hygiene. 

The  percentage  of  dental  defects  given  above  are 
for  large  cities,  where  there  is  a  great  mixture  of 
different  races  and  classes  of  people.  However,  the 
smaller  cities  and  towns  have  about  the  same  dental 
conditions,  and  even  the  people  of  the  agricultural 
regions  suffer  to  nearly  the  same  extent. 

These  children  enter  school  at  about  the  age  of  six 
years ;  many  at  this  early  age  have  decayed  teeth,  and 
mouth  and  throat  infection.    Few  have  been  properly 
taught  to  care  for  their  teeth,  and  the  result  is  that 
many  soon  have  dental  conditions  that  begin  to  give 
trouble.     The  degree    of  trouble    ranges    all  the  way 
from   an   occasional   toothache   to   more   serious   dis- 
orders, where  decayed  teeth  have  caused  abscesses,  or 
'*gum.-boils,"  which  discharge  pus  into  the  mouth ;  and 
.food   is  left  upon  and  between  decayed  teeth;    all  of 
which    is    mixed  with    the    saliva,    which    is    swal- 
lowed,   carrying  infection    into  the  stomach;     w^hile 
mouth-breathing,  from  which  many  suffer,  permits  in- 
fection to  be  carried  directly  into  the  lungs.     Some  of 
this  infected  saliva  is  spread  through  the  air  in  cough- 
ing and  talking,   and  some  deposited  on  the  ground  in 
spitting ;   all  of  which  becomes  a  further  source  of  in- 
fection to  the  children   in  the  room   and  on  the  play- 
grounds. 

The  mouth  is  a  warm,  moist,  cavity  and  where  there 
are  decayed  teeth  it  becomes  an  ideal  incubator  for 
disease  germs.    In  these  cavities  of  decay,  they  find  an 

—60— 


ORAL   HYGIENE,   DENTAL  AND  MEDICAL   EXAMINATION: 

ideal  field  in  which  to  develop.  Is  it  any  wonder  that 
tuberculosis,  pneumonia,  diphtheria,  infantile  paral- 
ysis, influenza  and  other  diseases,  are  so  prevalent 
among  school  children?  The  wonder  is  that  so  many^ 
escape. 

THE  RETARDING  EFFECTS  OF  BAD  ORAL 
CONDITIONS  ON  THE  CHILD.— The  effects  of  bad 
oral  conditions  may  be  seen  in  any  school-room. 
They  are  a  familiar  sight  in  the  schools  of  every  city, 
village  and  hamlet.  Doctors  and  dentists  know  the  im- 
portance of  the  mouth  as  an  entry-way  and  harboring 
place  for  germs  of  disease,  and  many  authorities  claim 
that  seventy-five  to  eighty  percent,  of  all  infectious 
diseases  make  their  entry  into  the  body  by  way  of  the 
mouth.  If  this  be  true,  and  it  can  easily  be  demon-- 
strated,  the  mouth  becomes  an  important  part  of  the 
body,  in  relation  to  disease.  When  a  child  is  fortun- 
ate in  inheriting  a  healthy,  normal  physical  consti- 
tution, and  the  habits  of  cleanliness  are  practiced, 
there  will  be  a  considerable  amount  of  natural  immun- 
ity from  ordinary  childhood  diseases,  which  protects 
the  child,  where  other  less  fortunate  children  suffer. 

Where  the  teeth  are  allowed  to  become  unclean, 
decay  soon  begins,  and  if  not  promptly  checked,  tooth- 
ache results.  A  child  with  an  aching  tooth  will  not  do 
good  school  work,  and  besides,  may  miss  several  ses- 
sions of  school  on  that  account. 

A  decayed  tooth  will  sometimes  cause  an  earache,  or 
trouble  with  the  eyes,  on  account  of  the  interrelation 
of  the  nerves  of  the  teeth  and  eyes.     This  is  a  detri- 

—61— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

ment  to  the  child,  and  holds  him  back  in  his  school 
work,  if  the  conditions  are  not  corrected. 

The  interrelation  of  the  tri-facial  nerve  over  the 
face,  including  the  teeth,  eye,  ear,  nose  and  throat, 
cause  many  cases  of  pain  that  are  referred  to  a  differ- 
ent part  from  where  the  trouble  really  arises.  Thus 
a  child  will  often  suffer  from  an  earache  when  the  ear 
is  entirely  normal.  A  decayed  tooth  sends  a  message 
of  pain,  which  is  transferred  to  the  ear,  or  even  to 
the  eye.  This  is  shown  to  be  true,  when  the  carious 
tooth  is  treated,  by  an  immediate  disappearance  of  the 
earache  or  eye  trouble.  This  also  works  both  ways, 
for  an  inflamed  ear  will  sometimes  cause  a  sensation 
of  pain  in  the  teeth.     (See  figure  40,  page  151) . 

Attention  has  been  called,  in  a  previous  chaptei*,  to 
mouth-breathing  in  children.  Children  breathe 
through  the  mouth  only  when  the  nasal  passages  are 
obstructed.  This  obstruction  is  usually  from  adenoids. 
It  is  safe  to  say  that  first  there  was  a  septic  mouth 
to  begin  infection.  These  mouth  breathers  have  con- 
tracted dental  arches,  usually  of  a  V  shape  in  the  up- 
per arch  (Fig.  4).  They  have  irregular  teeth,  which 
prevents  proper  mastication.  If  they  have  a  few  badly 
decayed  teeth,  as  they  do  in  many  cases,  which  harbor 
decayed  food  and  disease  germs,  often  abscesses  on 
the  gums  discharging  pus,  the  food  eaten  is  infected 
and  the  air  taken  into  the  lungs  contaminated. 

Our  schools  contain  many  such  children.  They  are 
anemic,  continually  suffer  in  the  winter  months  from 
coughs  and  colds,  and  are  not  only  physically  below  the 

—62— 


ORAL  HYGIENE,  DENTAL  AND  MEDICAL  EXAMINATION 

average,  but  usually  behind  in  their  classes.  Many 
contract  consumption,  and  become  a  burden  on  their 
family  or  the  State. 

BENEFITS  DERIVED  FROM  PREVENTION 
AND  CORRECTION  OF  BAD  ORAL  CONDITIONS. 
— It  is  the  duty  of  the  parents  to  see  that  their  child- 
ren have  a  heritage  of  good  health,  and  given  this,  it 
is  due  these  children  that  they  be  properly  taught  how 
to  preserve  their  good  health.  This  is  the  duty  of  the 
parents,  but  experience  teaches  us  that  they  often  fail 
to  give  proper  care  and  instruction  to  the  children ; 
not  always  from  lack  of  desire  for  their  welfare,  but 
more  often  from  a  lack  of  knowledge  of  what  is 
needed. 

The  State  recognizes  this,  in  regard  to  the  educa- 
tion of  the  children  of  this  country.  If  the  common 
school  education  of  their  children  were  left  entirely 
to  the  parents,  many  of  them  would  fail  to  give  their 
children  the  benefit  of  an  education.  Therefore,  the 
State  steps  in,  and  says  that  they  must  educate  their 
children.  If  the  parents  are  too  poor  to  provide  the 
necessary  books  for  their  children,  the  school  board 
furnishes  them  books.  The  State  further  provides 
shoes  and  clothing,  ,and  even  food,  so  that  a  child  may 
be  able  to  go  to  school  and  receive  an  education. 
Would  it  not  be  good  policy  to  go  a  step  farther,  and 
see  that  these  children  were  in  a  proper  physical  con-^ 
dition  to  profit  by  their  attendance  at  school,  and  were 
free  from  disease  that  might  be  communicated  to  other- 
children  ? 

—63— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

These  children  are  the  ones  who  need  most  the 
teachings  of  oral  hygiene,  and  medical  and  dental  care, 
to  prevent  disease.  They  live  in  poverty ;  their  homes 
are  poorly  warmed  and  ventilated;  they  are  not  as 
well  fed  as  they  should  be,  and  are  more  liable  to 
disease  from  being  in  a  sub-normal  condition.  Tuber- 
culosis is  only  dangerous  to  people  with  weakened 
constitutions,  and  it  is  well  known  that  the  chief  ob- 
ject of  its  treatment  is  to  improve  the  general  health 
of  the  patient. 

Many  children  contract  tuberculosis  during  infancy^ 
but  most  of  them  recover,  or  never  manifest  any  seri- 
ous form  of  the  disease.  This  is  due  to  the  normal 
means  of  defense  against  disease,  possessed  by  a  nor- 
mal body.  The  children  of  the  better  classes  of  people 
have  better  living  conditions,  better  medical  and 
dental  care  and  escape  or  recover  from  diseases  more 
readily. 

It  has  been  said  that  "we  have  the  poor  with  us  al- 
ways". While  this  is  true,  it  is  to  our  shame,  as  a 
civilized  people,  and  a  discredit  to  our  civilization. 

There  is  no  doubt  that  disease  contributes  much 
toward  poverty  conditions  in  this  country.  The  place 
to  attack  these  conditions  is  to  begin  with  the  children. 
Teach  them  to  live  clean  and  to  keep  clean,  so  they 
may  be  healthy  and  able  to  work,  and  become  useful 
citizens.  Healthy  men  and  women  usually  earn 
their  own  living,  and  do  not  become  public  charges. 
Wherever  right  living  conditions  are  established  in 
a  community,  there  poverty  and  disease  decrease.    Is 

—64— 


ORAL  HYGIENE,   DENTAL   AND   MEDICAL   EXAMINATION 

this  not  a  benefit?    The  place  to  begin  is  in  the  public 
schools. 

BENEFIT  OF  DENTAL  AND  MEDICAL  IN- 
SPECTION OF  PUBLIC  SCHOOL  CHILDREN.— 
The  children  of  the  better  classes  often  suffer  from 
bad  dental,  nose,  and  throat  conditions.  This  is  not 
because  the  parents  of  these  children  do  not  care,  but 
they  are  not  informed,  or  are  too  much  occupied  with 
the  cares  of  social  and  business  matters,  to  give  proper 
attention,  and  they  let  these  conditions  go  until  the 
child  calls  their  attention  to  an  aching  tooth.  Often 
serious  harm  has  resulted.  Dental  inspection  in  the 
schools  would  call  the  attention  of  the  parents  to  early 
dental  decay.  In  these  cases  a  card  is  given  to  the 
child,  who  takes  it  home  to  the  parents,  just  as  the 
monthly  grade  cards  are  taken  home.  On  this  card 
the  work  needed  is  marked  out.  The  parents  are  free 
to  go  anywhere,  and  have  any  dentist  do  the  work  for 
the  child,  and  while  this  is  not  obligatory  on  the  part 
of  the  parents,  that  they  must  have  the  work  done,  few 
of  them  but  are  ready  and  willing  to  give  this  service 
to  their  children,  and  glad  to  have  this  need  called  to 
their  attention,  at  a  time  when  it  can  be  done  cheaply 
and  without  pain  to  the  child. 

Medical  inspection  of  our  school  children  will  do 
much  for  the  health  of  the  community.  At  the  com- 
mencement of  the  school  term,  each  child  should  be 
examined  to  see  that  he  is  free  from  any  disease  that 
may  be  communicated  to  other  children,  and  for  any 
defects  that  may  prevent  him  doing  good  school  work. 

^65— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

Many  schools  in  the  larger  cities  even  go  so  far  as 
to  apply  tests  to  determine  the  mental  development  of 
the  child,  so  that  he  may  be  properly  provided  for. 
Medical  inspection  will  often  disclose  early  throat 
troubles  or  nose  affections,  which,  treated  early,  may 
be  removed ;  while  if  left  to  develop,  they  call  for  am 
operation  a  few  years  later.  An  example  of  such  is 
diseased  tonsils,  and  adenoids  in  the  nasal  passages. 

COST  OF  DENTAL  AND  MEDICAL  INSPEC- 
TION, AND  THE  BENEFIT  TO  THE  COMMUNITY 
AT  LARGE. — ^The  exact  cost  of  medical  and  dental 
inspection  for  any  given  school  is  determined  by  con- 
ditions. Conditions  in  one  community  may  make  liv^ 
ing  expenses  higher  than  in  some  other  communities. 
These  same  conditions  will  have  their  effect  on  the 
cost  of  everything  else,  medical  and  dental  services 
included. 

This  is  a  measure  to  benefit  public  health,  and 
can  be  purchased  like  any  other  community  want. 
The  size  of  the  school  or  the  size  of  the  city,  or  town, 
the  local  conditions,  the  degree  of  efficiency  and  the 
thoroughness  with  which  the  work  is  done  will  govern, 
to  a  great  extent,  the  cost.  In  small  towns  the  work 
could  be  done  by  having  the  children  go  to  the  local 
dentist  and  have  their  teeth  examined.  In  most  cases 
this  can  be  done  without  any  expense,  for  most  dentists 
are  willing  to  make  these  examinations  for  a  reason- 
able number  of  school  children.  New  work  which 
comes  to  them  repays  them  for  the  time  devoted  to 
examinations.    Where  the  schools  are  larger,  the  cost 

—66— 


ORAL   HYGIENE,   DENTAL  AND   MEDICAL   EXAMINATION 

of  having  the  examinations   made   by   specially   em- 
ployed dentists  is  not  great. 

Some  of  the  larger  cities  have  free  dental  clinics, 
where  those  unable  to  pay  for  dental  work  may  have 
their  teeth  taken  care  of  at  public  expense,  or  at  a 
nominal  cost,  where  they  are  able  to  pay  something, 
and  this  has  proved  to  be  money  well  invested. 

If  public  money  is  used  to  furnish  these  destitute 
children   with  books,   shoes   and   clothing,    and  some- 
times even  food,  would  it  not  be  good  policy  to  see- 
that  their  physical  condition  is  also  good,  so  that  these 
children  may  profit  by  their  work  in  school  ? 

In  many  places  the  oral  hygiene  work  and  public 
dental  clinics  have  been  started  by  public  spirited 
citizens,  who  have  contributed  directly  to  the  cause, 
and  by  dentists  who  have  given  their  time  to  the  work. 
This  has  been  done  in  several  cities,  and  the  work 
later  taken  over  by  the  public  health  department.  At 
first  small  appropriations  were  made  for  this  work, 
and  increased  as  the  scope  of  the  work  enlarged.  In 
the  larger  cities,  where  dentists  are  regularly  em- 
ployed in  the  school  dental  clinics,  the  salary  ranges 
from  $1200  to  $1500  per  annum,  for  each  dentist  em- 
ployed. In  smaller  cities  or  towns  it  may  not  be 
possible  to  establish  dental  clinics. 

However,  it  is  an  easy  matter  to  teach  oral  hygiene 
in  these  schools.  Physiology  is  taught,  and  a  course 
in  oral  hygiene  can  be  taught  along  with  this  subject. 
Tooth-brush  drills,  teaching  the  children  how  to  clean 
and  care  for  the  teeth,  will  add  little  if  anything  to  the 
cost  of  the  school  course. 

—67— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

In  cities  which  have  a  properly  organized  health 
department,  the  medical  inspection  can  be  conducted 
with  little  more  expense.  In  smaller  communities^ 
without  a  good  health  department,  the  school  board 
should  employ  a  physician  to  examine  the  children  at 
the  commencement  of  the  school  year,  and  none  but 
healthy  children  should  be  admitted  to  the  schools. 
Those  who  are  in  ill  health  should  be  required  to  take 
proper  measures  to  remedy  their  ill  health  so  that 
they  may  enter  school.  If  these  children  are  too  poor 
to  pay  for  their  own  care,  the  State  should  provide 
proper  medical  attendance,  to  set  them  on  the  road  to 
health,  and  enable  them  to  grow  up  into  healthy  men 
and  women.  With  good  health  and  an  education,  these 
children  will  become  useful  citizens,  able  to  support 
themselves.  Then  they  are  not  apt  to  become  a 
burden  on  society. 

On  the  other  hand,  many  of  these  defective  children,, 
if  their  infirmities  be  not  corrected,  become  a  prey  to 
disease  and  an  early  death,  or  they  drag  along  through 
life,  a  burden  on  society,  unable  to  acquire  an  educa- 
tion, and  too  weak  physically  to  compete  in  life's 
battles.  Therefore,  they  meet  defeat.  Our  alms- 
houses are  full  of  such  wrecks.  This  makes  a  further 
burden  of  tax  upon  our  people ;  a  burden  which  could 
be  avoided  in  many  instances  by  teaching  habits  of 
cleanliness,  and  remedying  hereditary  or  acquired  de- 
fects, before  serious  damage  is  done  to  the  growing 
child. 

We  have  also  another  type  of  boys  and  girls  who  are- 

—68— 


ORAL  HYGIENE,  DENTAL  AND  MEDICAL  EXAMINATION' 

seemingly  not  weak  physically.  They  appear  to  be 
normal,  healthy,  strong  children.  They  seem  to  get 
along  as  well  as  other  children  at  first.  They  may  be 
leaders  of  their  particular  set ;  adepts  in  all  the  sports 
of  childhood  and  one  might  say  that  they  are  all  right, 
that  there  is  nothing  the  matter  with  them.  This  is. 
true  of  most  of  them,  but  of  some  it  is  not.  When 
these  children  enter  school,  some  of  them  find  it  their 
first  stumbling-block.  These  are  the  children  with  de- 
fective eyesight,  hearing,  or  some  of  the  various  de- 
fects which  may  have  begun  at  birth,  or  may  have 
been  acquired  from  bad  oral  conditions.  As  long  as 
they  are  engaged  in  outdoor  exercises,  they  get  along 
all  right.  As  soon  as  they  are  confined  within  the 
school  they  become  restless ;  study  becomes  an  impleas- 
ant  task,  and  the  physical  sense  of  uneasiness  often, 
becomes  unbearable. 

Unless  these  conditions  are  discovered  and  correct-- 
ed,  the  result  will  be  that  these  pupils  will  study  as 
little  as  possible.  They  will  stay  away  from  school 
whenever  they  have  the  opportunity.  When  in  school^ 
they  will  be  more  apt  to  be  engaged  in  mischief,  which 
soon  gets  them  into  trouble  with  their  teacher.  The 
lack  of  study  results  in  failure  to  get  promotions,  and ; 
with  the  tendency  to  mischief,  soon  causes  these  child- 
ren to  be  looked  upon  as  delinquent.  Punishment  and 
failure  to  receive  promotion  give  these  pupils  a  dis- 
taste for  school,  which  often  results  in  giving  them  a 
resentful  attitude  toward  society,  which  is  here  repre- 
sented by  the  school. 

—69— 


E 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

On  the  playground  these  children  are  the  recipients 
of  the  admiration  of  their  playmates ;  in  school  they 
are  the  objects  of  reproach  and  ridicule.  Is  it  any 
wonder  that  some  of  these  unfortunates  are  truants 
from  school,  or  if  they  go  to  school  for  a  time,  that 
they  quit  as  soon  as  they  reach  the  age  of  school  ex- 
emption ? 

Some  of  these  may  go  to  work,  but  others  become 
idlers,  and  soon  get  into  trouble;  these  youngsters, 
the  boys  especially,  are  very  liable  to  take  up  with 
other  boys  whose  associations  have  led  them  into 
various  crimes.  The  story  is  a  familiar  one  in  any  of 
our  large  cities,  and  to  a  great  extent  in  the  smaller 
cities  and  towns.  They  soon  meet  with  society  i^  an- 
other combat.  This  time  it  is  the  jpolice.  They  are  ar- 
rested, imprisoned  and  given  a  term  in  the  reform  or 
training  school.  Some  of  these  boys  and  girls  may  be 
reformed  by  their  training  while  detained  in  these  in- 
stitutions. Many  are  not.  Their  resentment  toward 
society  continues,  and  they  become  criminals  for  the 
remainder  of  their  lives. 

Criminals  are  just  ordinary  human  beings,  the 
greater  percent,  of  whom  are  suifering  from  some  pre- 
ventable or  remediable  defect.  The  others  are  prob- 
ably insane,  and  should  be  treated  as  insane. 

Medical  and  dental  inspection  of  these  defectives  in 
early  life  will  enable  society  to  discover,  and  remedy 
or  prevent  many  of  these  defects,  and  save  a  great 
Inany  boys  and  girls  for  a  useful  and  productive  life. 
The  cost  of  this  prevention  is  little  in  comparison  to 

—70— 


ORAL  HYGIENE,  DENTAL   AND   MEDICAL   EXAMINATION 

the  cost  of  building  and  maintaining  prisons  in  which 
to  confine  these  unfortunates  after  they  have  become  a 
menace  to  society.  What  we  spend  in  court  costs  on 
preventable  crime  would  more  than  pay  for  all  the 
school  inspection  we  will  ever  need. 

One  of  our  great  American  surgeons  recently  said 
that  the  next  great  step  in  preventive  medicine  should 
come  from  the  dentists,  and  asked:  'Will  they  do  it?" 
He  might  have  added,  crime  prevention.  The  medical 
and  dental  men  of  this  country  are  ready  and  willing 
to  do  their  part.  Are  you,  Mr.  Taxpayer,  ready  to 
help  them  ? 


-^71— 


ORTHODONTIA,  OR  STRAIGHTENING 
IRREGULAR  TEETH. 

CHAPTER  V. 

The  average  healthy  child  who  has  had  proper  care 
of  the  mouth,  who  has  been  taught  to  keep  it  clean, 
whose  teeth  are  free  from  decay,  and  who  has  been 
fortunate  in  escaping  early  colds,  adenoids  or  infected 
tonsils,  and  has  not  formed  wrong  feeding  habits,  or 
other  vicious  habits,  such  as  mouth-breathing  or 
thumb-sucking,  will  have  a  regular,  well  formed  set  of 
temporary  teeth.  Usually  the  temporary  teeth  will  be 
close  together  until  about  four  years  of  age,  after 
which  they  should  begin  to  separate  a  little,  because  of 
the  growing  arch  enlarging.  When  this  separation 
does  not  take  place  it  denotes  that  the  child  has  suf- 
fered an  arrest  of  development,  which  he  cannot  over- 
come unaided. 
By  the  age 
of  six  years 
this  separa- 
tion should  be 
wide  enough 
so  that  when 
the  temporary 
teeth  are  shed 
there  will  b  e 
room  for  the 
wider  perman- 

Figure  VI.  The  ten  upper  deciduous  teeth.         ^^it      teeth      tO 

^72— 


ORTHODONTIA.  OR  STRAIGHTENING  IRREGULAR  TEETH 

come  in  without  crowding.  If  this  separation  takes 
place  normally,  the  new  teeth  will  come  in  straight; 
if  it  does  not,  the  new  teeth  will  be  ''crooked"  or  over- 
lap each  other.  (Fig.  4,  Chap.  II.). 

In  Figure  6,  a  photograph  of  a  plaster  model  of  a 
child's  upper  teeth,  age  five  years ;  notice  the  separa- 
tion of  the  teeth  on  the  right  side  of  the  model.  (Left 
side  of  the  face.)  This  separation  should  give  room 
for  the  eruption  of  the  larger  permanent  teeth.  How- 
ever, there  is  no  separation  on  the  opposite  side,  or  be- 
tween the  central  incisors,  and  unless  this  defect  is  cor- 
rected, that  is,  the  separation  made  the  same  on  botk 
sides,  the  teeth  will  be  crowded  and  irregular.  Figure 
4  is  that  of  a  girl,  age  9  years,  showing  the  crowded 
condition  which  will  result  unless  this  defect  is  cor- 
rected. 

When  the  bones  of  the  face  develop  normally,  and 
the  temporary  teeth  are  shed  at  the  proper  time,  the 
permanent  teeth  erupt  in  order,  and  the  new  set  of 
teeth  are  at  least  approximately  even.  When  decay 
attacks  the  teeth,  causing  too  early  a  loss,  or  the  ton- 
sils become  infected,  adenoids  form,  and  breathing- 
through  the  mouth  is  practiced,  the  dental  arches  are 
forced  into  an  abnormal  shape,  or  they  are  prevented 
from  growing  and  developing  as  they  should.  Then 
the  permanent  teeth  come  in  ''crooked."  They  are  in 
all  sorts  of  positions,  growing  inside  the  regular  line 
of  the  arch,  toward  the  roof  of  the  mouth,  or  out  to- 
ward the  cheek,  turned  half  way  around  in  their 
sockets,    or    some    of   them    overlapping    each    other^ 

—73— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


Sometimes  the  upper  teeth  may  close  inside  the  lower, 
when  normally  the  upper  teeth  should  close  over  the 
lower  teeth. 

The  first  six  or  seven  years  of  a  child's  life  are  said 
to  be  the  formative  period  of  his  life.    What  the  child 

learns  now 
and  the 
habits  he 
forms,  will 
influence 
his  entire 
after  life. 
This  is 
t  r  u  e*  i  n 
both  the 
physic- 
al  and  the 
mental  life 

Figure  VII.  Models  of  irre.u'ular  teeth.     Where  the    ^  ^        t  n  e 
teeth  are  very  irre.u'ular  the  bones  of  tlie  head  and    child.      One 
face  Will  be  out  of  shape.  .t,  , 

Will  surely 
influence  the  other.  If  the  physical  development  is 
g'ood,  the  child  will  have  a  m.uch  better  chance  for  a 
normal  mental  development. 

The  avera-^e  child  is  born  healthy,  but  all  children 
do  not  remain  so.  By  unclean  oral  (mouth)  habits, 
early  colds,  bad  feeding  habits,  or  vicious  practices, 
the  normal  growthi  may  be  perverted.  Adenoids, 
diseased  teeth  and  tonsils,  soon  exert  their  harmful 

—74— 


ORTHODONTIA.  OR  STRAIGHTENING  IRREGULAR  TEETH 

effects.  The  first  effect  will  be  in  regard  to  breathing. 
The  air  passages  through  the  nose  are  reduced  in  size 
by  enlargement  of  the  adenoids.  This  causes  the  child 
to  hold  the  mouth  open  for  breathing,  and  causes  the 
cheeks  to  be  drawn  down  until  they  press  against  the 
outside  of  the  arches  and  push  them  out  of  shape.  The 
bony  frame  work  of  the  faces  of  young  children  is 
very  easily  changed  m  shape,  because  these  bones  are 
not  solidified. 

The  tongue  and  lips  also  help  shape  the  dental  arch- 
es. When  the  mouth  is  held  open,  the  tongue  is  drawn 
away  from  the  teeth,  and  does  not  press  against  them 


Fi.aiire  VIII.  Case  of  Y  shaped  upper  arc?!.  Diie  to 
jnoutli-breathing   and   tliunili-sucliing. 
Courtesy,  lilue  Island  Specialty  Co. 

—75— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

normally.  Neither  do  the  lips.  This  pressure  of  the 
cheeks  and  lips  on  the  outside  of  the  arches,  with  the 
lack  of  the  tongue  pressure  on  the  inside,  which  norm- 
ally gives  shape  to  the  dental  arches,  causes  the  arch  to 
grow  in  a  V  shape. 

This  causes  a  restriction  of  the  breathing,  affecting 
the  supply  of  oxygen,  which  soon  affects  the  lung  de- 
velopment, and  retards  the  development  of  the  entire 
body.  These  teeth  being  irregular,  the  child  is  not 
able  to  properly  masticate  the  food,  and  as  irregular 
teeth  are  more  liable  to  decay,  because  of  the  difficulty 
in  properly  cleaning  them,  there  will  usually  be  found 
a  certain  amount  of  decay  and  f ermentaton ;  the  pro- 
ducts of  which  are  mixed  with  the  food  and  saliva  and 
taken  into  the  digestive  system,  and  produce  disorders 
of  digestion.  If  this  influence  is  continued,  it  will 
•often  affect  the  mentalitj^  of  the  child,  because  an  ill- 
nourished  child  will  not  have  the  ambition  to  work 
and  study  that  a  well-nourished  and  vigorous  one  will 
liave. 

The  early  discovery  of  any  condition  that  will 
Tetard  the  growth  of  the  child  is  very  desirable,  and  if 
faulty  conditions  are  found,  it  becomes  much  more  de- 
sirable to  correct  these  conditions  before  serious  harm 
is  done.  These  conditions  develop  early,  and  should 
be  attended  to  promptly,  before  the  formative  period 
of  childhood  ends,  which  is  by  the  end  of  the  sixth  or 
seventh  year. 

This  is  the  duty  of  the  parents,  for  few  children 
are  in  school  before  six  years  of  age.    A  child  two  or 

—76— 


ORTHODONTIA.  OR  STRAIGHTENING  IRREGULAR  TEETH 

three  years  old  is  not  too  young  to  visit  the  dentist 
twice  a  year,  and  have  examinations  made  to  discover 
defects  of  faulty  development  of  head  and  face,  nose 
and  dental  arches,  or  decay  in  the  teeth. 

Children  who  *'just  grow  up",  and  do  not  have  their 
dental  defects  corrected  by  the  time  they  enter  school, 
which  is  usually  at  six  or  seven  years  of  age,  will  suf- 
fer in  various  ways.  Some  will  be  stoop-shouldered, 
have  a  curved  spine,  or  a  badly  developed  thoracic 
cavity.  Others  are  anemic.  We  call  them  backward 
pupils.  The  least  that  usually  happens  is  irregular 
and  decayed  teeth,  which  annoy  them  more  or  less  in 
their  work  and  play. 

If  a  child  does  not  breathe  freely  it  cannot  develop 
right.  After  these  deformities  have  occurred,  the 
next  question  is  how  to  correct  them.  In  young  child- 
ren this  is  usuall}^  a  simple  matter.  The  tissues  are 
soft  and  easily  molded  into  place.  If  the  child  has 
adenoids  or  diseased  tonsils,  and  is  a  mouth-breather, 
the  arch  will  usually  be  found  compressed  or  V 
shaped,  and  the  vault  or  roof  of  the  mouth  high. 

The  raising  or  arching  of  the  vault  of  the  mouth 
restricts  the  space  in  the  nasal  passages.  Spreading 
this  V  shaped  arch  out  to  the  form  nature  intended  it, 
will  separate  or  spread  the  temporary  teeth  so  that 
the  permanent  teeth  will  tend  to  come  in  straight.  At 
the  same  time  the  nasal  passages  above  will  be  spread, 
and  the  vault  or  roof  of  the  mouth  will  take  its  proper 
shape.  This  allows  the  nasal  septum  to  grow  straight, 
and  this,  with  the  removal  of  the  adenoids,  allows  re- 

—77— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

sumption  of  proper  breathing.  If  the  tonsils  are 
diseased,  they  should  be  looked  after,  in  order  that 
the  throat  passage  may  be  cleared  up  and  made 
healthy. 

The  correction  of  these  defects  is  best  done  early. 
Some  operators  are  able  to  get  good  results  for  child- 
ren three  and  a  half  or  four  years  old.  These  defects 
should,  however,  be  corrected  by  the  time  the  child  is 
six  or  seven  years  old.  The  arches  are  easily  spread 
at  these  ages;  generally  only  a  few  weeks — ^ten  or 
twelve — are  required  for  the  spreading  process.  If 
the  child  is  under  six  years  of  age,  the  arch  will  not 
need  much  spreading  to  allow  regular  eruption  of  the 
permanent  teeth,  and  a  correction  of  the  nasal  ob- 
structions. Less  than  one-fourth  of  an  inch  will  usu- 
ally be  sufficient  spreading  for  children  six  years  of 
age  or  less. 

Very  slight  pressure  is  all  that  is  necessary  to  effect 
the  movement,  and  this  can  be  applied  by  means  of  a 
small  gold  arch  spring  attached  to  the  teeth.  After 
the  arches  are  spread  a  retaining  appliance  should  be 
worn,  until  the  first  permanent  molars  erupt,  to  pre- 
vent the  arch  returning  to  the  former  contracted  po- 
sition. 

In  order  to  impress  the  importance  of  the  need  to- 
correct  early  dental  irregularities,  let  us  briefly  re- 
view what  happens  to  most  children  with  bad  oral 
conditions. 

These  irregularities  begin  with  some  obstruction 
of  the  nasal  passages.     This  causes  the  child   to  hold 

—78— 


ORTHODONTIA.  OR  STRAIGHTENING  IRREGULAR  TEETH 

the  mouth  open,  and  the  breathing  is  done  through  the 
mouth.  The  air  thus  enters  the  lungs  without  being 
cleansed  of  impurities,  which  would  not  happen  if 
breathing  was  through  the  nose,  where  the  fine  hairs 
of  the  nostrils  catch  and  prevent  dust,  etc.,  from  en- 
tering the  lungs.  This  mouth  breathing  results  in 
malformed  arches,  which  crowd  the  roof  of  the  mouth 
up  and  contract  the  nasal  space.  For  it  should  be 
noted  that  the  roof  of  the  mouth  is  also  the  floor  of 
the  nasal  cavity. 

The  question  may  here  be  asked  why  the  child  can- 
not receive   as  much   air  into   the   lungs   through  the 
mouth  as  he  could  through  the  nose,  were  the  passages 
in  the  nose  opened ;     for  instance  by  the  removal  of 
the  adenoids.    Most  of  them  do  not,  because  they  also 
have  diseased  tonsils  to  help  stop  up  the  air  passages 
in  the  throat.    The  results  of  these  bad  conditions  are 
that  impure  air  is  taken  into  the  lungs,   and  the  lungs 
are  infected  with  disease  germs.    The  influence  of  such 
conditions    reduces    the  vital    force,    and  the  child  is 
anemic.    Frequently  these  children  are  undersized,  and 
backward  mentally    as  well    as  physically.    In    many 
cases  a  renewal  of  normal  development    and    bodily 
vigor  will  be  accomplished  by  a  correction  of  these  ab- 
normal conditions. 

MANAGING  YOUNG  PATIENTS.— Many  people, 
and  some  dentists,  have  an  idea  that  work  cannot  be 
done  successfully  for  very  young  patients.  But  this  is 
not  true,  for  almost  any  dentist  can  gain  the  confidence 
of  these  little  patients,  provided  the  ''grown-ups"  at 

—79— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

home  have  not  previously  instilled  a  dread  into  the 
mind  of  the  little  one.  If  any  dentist  says  the  child  i& 
too  young,  it  will  usually  be  because  he  has  not  the 
knack  or  the  patience  to  work  with  these  little  ones. 
In  such  cases  it  will  be  wise  to  consult  another  dentist, 
one  who  will  have  the  patience  to  gain  the  friendship 
af  these  little  ones,  and  do  what  is  needed  to  correct 
these  defects  at  a  time  when  it  will  do  the  most  good. 
There  is  an  old  saying  to  this  effect:  "As  the  twig  is 
bent,  so  will  the  tree  grow."  Why  not  apply  this  prin- 
ciple to  the  growing  child  ? 

Accompanying  are  photographs  of  an  early  case,  as 
it  appeared  before  operation,  and  the  after  appear- 
ance. 

"Case  E.  O'D".  Child  seven  years  old.  Notice  the  two 
portraits  taken  before  widening  of  the  arches  was  be- 
gun. Note  the  position  in  Figure  9 — mouth  open, 
head  leaning  forward,  the  stoop-shouldered  position. 
In  Figure  10  the  same  is  shown  with  side  view.  Note 
the  listless  appearance  of  the  face.  Note  the 
erect  appearance,  after  operation,  in  Figure  11 — the 
head  held  up,  neck  straight,  mouth  closed.  Also  Fig- 
ure 12,  with  side  view.  The  little  boy  here  shown 
has  had  the  dental  arches  widened.  This  also 
widened  the  nasal  space,  giving  plenty  of  breath- 
ing space  in  the  nose.  Plenty  of  oxygen  is  taken  into 
the  lungs,  and  by  the  normal  manner  of  breathing. 
The  teeth  were  put  in  a  normal  position,  which  en- 
abled him  to  masticate  his  food  properly.  He  was 
starving  for  oxygen,  and  as  soon  as  he  received  a  gen- 

—80— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


-i. 


< 


—81— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


y. 


fee      - 


c 


—82- 


ORTHODONTIA.  OR  STRAIGHTENING  IRREGULAR  TEETR 

erous  supply,  and  was  able  to  chew  his  food  properly, 
he  began  to  develop  in  a  normal  manner. 

REGULATION  OF  THE  PERMANENT  TEETH. 
— While  it  is  very  desirable  that  the  temporary  set  of 
teeth  be  cared  for,  so  that  the  permanent  teeth  will 
^come  in  even,  this  care  is  not  always  given,  and  re-^ 
suits  in  many  cases  of  irregular  permanent  teeth. 
Patients  of  all  ages  consult  dentists  in  regard  to 
their  irregular  teeth,  and  most  of  them  have  the  idea, 
that  they  should  wait  until  they  are  grown  before  this 
work  is  attempted.  Most  dentists  who  do  Orthodon- 
tia, would  prefer  to  have  their  patients  under  nine 
years  of  age,  or  not  over  ten.  From  six  to  nine  years 
is  a  very  good  time  to  have  this  work  done.  The  tis- 
sues are  more  easily  molded  into  place  than  when  the 
work  is  done  after  the  teeth  are  all  in  place  and  have 
their  full  root  development,  and  the  bony  parts  of 
the  face  become  set.  However,  if  the  child  has  grown 
up  with  an  irregular  set  of  teeth,  and  desires  to  have 
them  straightened,  it  may  still  be  done,  but  it  takes 
longer,  and  more  work  is  required  to  get  results. 

The  general  health  of  the  patient,  and  the  amount 
of  school  work  required  of  him,  should  govern  the 
time.  For  some  this  can  be  done  at  twelve  to  fifteen 
years.  It  should  be  done  earlier,  if  possible.  Before 
&ix  years  is  better. 

During  the  age  of  puberty,  it  might  not  be  well  to 
attempt  this  kind  of  work  for  some  patients,  especial- 
ly girls.  However,  that  should  be  left  to  the  discre- 
tion of  the  dentist. 

,      —83— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

The  work  should  begin  so  that  it  can  be 
finished  by  the  time  the  patient  is  fifteen  or  sixteen 
years  old,  twenty  at  the  latest.  For  after  these  ages 
the  tissues  have  become  set  and  require  a  longer  time 
to  accomplish  the  regulation,  and  work  a  greater  hard- 
.sjiip  on  the  patient.  • 


—  ^,4- 


FILLING  AND  TREATING  TEETH. 

CHAPTER  VI. 

Few  people  have  clear  ideas  in  regard  to  filling 
teeth.  Most  of  them  think,  that  after  a  tooth  has  ached, 
is  soon  enough  to  have  it  filled.  But  this  not  true,  for 
then  it  is  often  coo  late,  or  the  decay  has  progressed 
so  far  that  filling  will  not  restore  the  tooth  as  well  as 
if  it  had  been  done  sooner.  The  time  to  fill  a  tooth  is 
just  as  soon  as  decay  begins.  If  this  is  done  it  takes 
little  cutting,  causes  little  or  no  pain,  and  takes  very 
little  time  to  do  the  work.  When  the  work  is  done 
this  way,  it  can  be  done  well,  and  restores  the  tooth  to 
usefulness,  and  the  filling  will  stay  in  and  give  no 
trouble.  Besides  it  costs  less  to  have  the  work  done 
at  this  time. 

On  the  other  hand,  if  the  teeth  are  let  go  until  they 
ache,  it  may  take  several  trips  to  the  dentist  to  have 
the  work  completed.  It  is  also  likely  to  hurt  some,  will 
cost  a  great  deal  more  money,  and  does  not  give  as 
good  service  after  it  is  filled  as  work  done  early. 

The  child  who  has  had  good  care  of  the  mouth  until 
seven  years  of  age,  and  is  taught  to  keep  the  mouth 
clean,  will  not  be  liable  to  have  trouble  with  decay. 
Making  regular  visits  to  the  dentist,  having  every 
little  decayed  spot  taken  care  of,  will  avoid  trouble 
with  decayed  teeth. 

If  the  teeth  are  preserved  until  adult  age,  the  chance 
is  good  to  keep  them  throughout  life,  for  there  is  really 

—85— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

no  physical  reason  why  the  teeth  should  not  be  retained 
until  old  age,  and  be  useful  during  all  that  time. 

CAUSE  OF  DECAY.— The  causes  which  lead 
to  decay  of  the  teeth  are  numerous,  especially  in 
highly  civilized  countries.  One  of  the  princi- 
pal causes  is  uncleanliness.  Food  lodged  be- 
tween the  teeth,  and  in  the  pits  or  depressions,  if 
left,  soon  ferments.  The  mouth  is  moist  and  warm, 
and  fermentation  and  chemical  changes  take  place. 
The  bacteria  form  an  acid,  which  dissolves  the  enamel. 
If  there  are  defects  in  the  teeth  like  deep  fissures,  the 
decay  forms  faster  and  the  small  cavity  soon  becomes 
a  large  one.  If  not  filled  it  will  soon  reach  the  pulp  (or 
nerve)  of  the  tooth,  and  cause  it  to  ache.  The  pulp 
may  then  have  to  be  removed,  or  even  the  tooth  may  be 
lost  by  the  neglect. 

Another  cause  which  makes  the  teeth  decay,  is  sick- 
ness, which  lowers  the  vitality  of  the  body.  Those  who 
are  ill  should  take  special  precaution  to  keep  the 
mouth  clean  and  the  teeth  free  from  deposits. 

Excessive  study  or  worry,  without  exercise,  may 
weaken  the  system,  and  the  teeth  may  suffer  as  a  con- 
sequence. Irregular  teeth  are  hard  to  keep  clean  and 
show  a  tendency  on  this  account  to  decay.  Various 
diseases  of  childhood  affect  the  teeth,  and  they  may 
not  develop  evenly.  Fissures  are  often  found  in  the 
teeth,  which  harbor  decay  germs,  and  these  teeth  de- 
cay easily.  The  one  great  cause  of  decayed  teeth 
among  civilized  peoples  of  today,  is  because  so  many 
live  on  luxuries,  the  prepared  breakfast  foods,  and  fine 

—86— 


FILLING   AND   TREATING   TEETH 


white  bolted  flour,  from  which  three  fourths  of  the 
qualities,  which  are  bone  and  tooth  builders,  are  re- 
moved.    The  Vitamines  are  also  removed. 

FORM  OF  TEETH.— The  teeth  are  made  of  enamel, 

cementum,       and 
the  pulp  or  nerve. 

The  root  is 
covered  by  the 
peridental  mem- 
brane, and  set  in 
the  Alveolar  pro- 
cess, the  bony 
support  of  the 
teeth  over  the 
jaw  bone.  Cer- 
tain diseases  in- 
jure this  mem- 
Figure  XITL  Cuspid  teeth,  ground  down,  b  r  a  U  e,  CaUSing" 
showing  enameh  dentine,  pulp  chamber,  and  .i^  teeth  tO  loOS- 
roots  of  teetii.   (Enlarged.) 

en,  or  be  lost. 

THE  ENAMEL. — This  is  the  hard,  white,  outer  cov- 
ering of  the  tooth,  and  is  the  hardest  substance  in 
the  body.  It  is  clear,  lustrous  and  translucent.  The 
color  varies  in  different  people.  Children  usually  have 
white  teeth,  and  the  second  set  of  teeth  may  be  white 
in  color,  or  may  be  of  a  yellowish  or  bluish  cast. 

Young  people's  teeth  are  usually  whiter  than  those 
of  older  people.  Teeth  may  change  color.  This  is 
due  to  the  changes  in  the  teeth  caused  by  foods,  the 

—87— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

changes  of  age,  use  of  tobacco  in  chewing  or  smoking, 
and  sometimes  medicines  taken  into  the  mouth.  Real 
hot  food  or  drinks,  or  real  cold  things  against  the 
enamel,  will  often  cause  checks  or  cracks  to  come  in  the 
enamel.  Especially  is  this  true  of  sudden  changes 
from  hot  to  cold,  or  cold  to  hot  substances. 

The  enamel  is  formed  of  little  enamel  rods  of  a 
wavy  or  gnarled  appearance.  These  rods  are  closely 
bound  together,  and  run  lengthwise  from  the  dentine 
to  the  outside  of  the  crown  of  the  tooth.  The  entire 
tooth  above  the  gum  line  is  covered  with  enamel. 

THE  DENTINE.— The  dentine  forms  the  greater 
bulk  of  the  hard  tissues  of  the  tooth,  and  is  covered 
by  the  enamel. 

The  hollow  space  in  the  middle  of  the  tooth  contains 
the  pulp  or  **nerve." 

The  dentine  contains  a  great  number  of  minute 
tubules  or  canals  which  connect  with  the  pulp  of  the 
tooth.  The  dentine  is  a  hard,  elastic  substance,  has  a 
yellowish  tinge,  and  is  very  sensitive. 

When  the  enamel  covering  is  injured  by  decay,  and 
cavities  form,  the  exposed  dentine  becomes  sensitive 
to  heat  or  cold,  or  sweets,  and  to  pressure  of  food 
particles,  and  toothache  results.  If  decay  goes  on  the 
pulp  is  exposed,  and  serious  pain  results. 

THE  PULP. — The  pulp  is  the  soft  vascular  tissue 
contained  within  the  hollow  part  of  the  crown  of  the 
tooth  and  root.  It  contains  blood  vessels  and  nerves, 
which  enter  at  the  small  open  end  of  the  root.  When 
decay  destroys  the  enamel  and  dentine,  the  pulp  be- 

—88— 


FILLING   AND   TREATING   TEETH 

comes  exposed,  and  it  then  becomes  necessary  to  de- 
stroy this  pulp  or  *'nerve",  and  clean  the  root  canal 
out,  and  fill  it  with  some  inert  substance  which  will 
completely  fill  the  interior  of  this  cavity,  and  prevent 
any  moisture  entering  from  the  end  of  the  root.  After 
this  is  done  the  tooth  can  be  filled  or  crowned. 

THE  CEMENTUM.— The  cementum  is  a  modified 
bone,  covering  the  root  or  fang  of  the  tooth.  It  meets 
the  enamel  edge  to  edge,  and  is  covered  by  a  thin 
membrane  called  the  Pericementum,  or  Peridental 
membrane,  which  forms  a  cushion  around  the  root 
of  the  tooth,  which  is  set  firmly  in  the  Alveolar  pro- 
cess. The  Alveolar  process  is  that  part  of  bone  which 
is  continuous  with  the  body  of  the  maxillae,  or  jaws, 
and  supports  the  teeth. 

PREPARATION    OF    TEETH    FOR    FILLING.— 

The  preparation  that  the  cavity  receives  will  deter- 
mine the  usefulness  of  the  filling  in  the  tooth.  All  the 
decay  should  be  removed  and  the  tooth  cut  down  until 
healthy  dentine  is  reached,  and  all  overlying  enamel 
removed  from  the  cavity.  The  margins  of  the  cavity 
should  be  cut  back  so  that  when  the  filling  is  put  in,  the 
joint  will  not  come  against  the  adjoining  tooth.  If  it 
does  the  tooth  is  very  liable  to  decay  again,  for  food 
will  lodge  there,  and  a  brush  will  not  clean  and  polish 
the  margin  of  the  filling  as  it  should. 

Where  decay  is  between  the  teeth,  the  cavity  should 
be  extended  below  the  gum  to  prevent  a  recurrence  of 
the  decay.     All  grooves  in  the  top  of  the  tooth  should 

—89— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

be  cut  out  to  the  rounding  cusps  of  the  teeth,  so  decay 
germs  cannot  lodge  there. 

When  decay  is  thoroughly  removed,  and  the  cavity 
cut  out  properly,  a  filling  can  be  placed  which  will 
give  long  service,  and  it  is  worth  the  time  and  discom- 
fort endured. 

However,  it  is  not  always  possible  to  do  such  thor- 
ough work.  The  age,  the  health,  or  the  sensitiveness- 
of  the  patient  will  often  prevent  doing  all  that  should 
be  done.  Young,  or  sensitive  people,  will  not  always  al- 
low the  dentist  to  cut  into  sensitive  dentine  and  extend 
the  cavity  as  it  should  be.  Sometimes  it  may  not  be  pos- 
sible to  remove  all  decay,  but  it  should  be  removed  by 
all  means,  or  the  tooth  will  decay  under  the  filling. 
Work  that  is  half  done  will  have  to  be  done  over  some 
day. 

The  dentist  is  often  asked  if  it  is  safe  to  fill  teeth  for 
women  in  delicate  health.  Usually  this  can  be  done 
with  perfect  safety  and  comfort  for  these  patients^ 
but  the  dentist  should  be  informed  of  the  condition. 
Temporary  work  at  least  can  be  done,  which  will  pre- 
serve the  teeth  until  such  time  when  permanent  work 
can  be  done.  If  teeth  are  let  go,  and  toothache  and 
abscesses  result,  the  discomfort  and  danger  will  be 
greater  than  that  from  any  dental  operation  that  may 
be  done  at  this  time.  Teeth  may  even  be  extracted 
with  safety,  and  it  is  much  better  to  have  this  done, 
if  the  tooth  cannot  be  saved,  than  to  endure  prolonged 
suffering  from  diseased  teeth. 

FILLING  MATERIALS.— A  good  many  materials 

—90— 


FILLING  AND  TREATING   TEETH 

have  been  tried  for  filling  the  teeth,  but  gold,  amalgam, 
and  the  different  cements,  are  the  principal  ones  used. 

GOLD.^Gold  has  long  been  a  favorite  filling  ma- 
terial, with  both  patients  and  dentists.  Its  color  is 
good,  and  if  anything  is  used  that  will  show  at  all, 
gold  is  chosen  by  the  patient  because  of  its  appear- 
ance. The  dentist  uses  it  because  it  is  malleable  and 
a  good  filling  can  be  made  of  it,  and  one  that  will  not 
be  apt  to  leak  and  expose  the  tooth  to  decay. 

Gold  can  be  worked  over  little  margins  or  edges  of 
a  cavity,  and  will  stay  without  breaking  off.  In  other 
words  it  has  edge  strength,  and  is  adapted  for  filling 
cavities  peculiar  to  front  teeth. 

GOLD  INLAYS. — During  recent  years  a  form  of 
gold  filling  has  been  perfected  which  does  away  with 
long  operations.  This  is  the  gold  inlay.  The  cavity 
is  prepared  without  any  undercuts  or  mortices,  so  that 
it  may  be  filled  with  wax,  which  is  shaped  up  as  the 
filling  is  desired.  This  wax  is  removed  and  invested  in 
a  cast,  and  the  wax  melted  out,  after  which  gold  is 
melted  and  cast  in  this  mold.  This  reproduces  the 
wax  filling  in  gold.  This  is  set  in  the  cavity  and 
polished  up,  after  which  it  is  cemented  into  place.  This 
makes  a  nice  filling  and  does  away  with  long  opera- 
tions and  the  pounding  necessary  in  working  the  gold 
foil  fillings. 

AMALGAM. — Amalgam,  or  ''silver  fillings,"  are 
used  principally  for  the  back  teeth,  those  hidden  from 
sight,  in  the  mouth.  Gold  is  sometimes  used  in  these 
back  teeth,   but   usually   amalgam   fillings   are   used. 

—91— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

They  preserve  the  teeth  just  as  well,  and  are  easier  and 
cheaper  to  put  in. 

It  is  very  hard  to  put  in  a  good  gold  filling  in  a  com- 
pound or  double  cavity  in  the  back  teeth.  It  is  hard 
to  get  the  margins  or  edges  of  the  filling  so  that  no 
septic  matter  can  seep  in  and  cause  decay,  and  it  may 
not  be  advisable  to  try  a  gold  inlay. 

Besides  the  work  is  very  tiresome  on  the  patient 
where  the  gold  filling  is  very  large.  Amalgam  can  be 
placed  much  easier,  and  will  preserve  the  tooth  from 
decay,  and  patient  and  dentist  will  both  be  better' 
off.  A  good  amalgam  filling  is  worth  more  than  any 
number  of  bad  gold  fillings. 

After  the  cavity  is  properly  prepared,  much  depends 
on  properly  mixing  and  inserting  a  "silver"  filling. 
The  cavity  should  be  dry,  and  the  amalgam  tightly 
packed  in  and  shaped  up  with  the  tooth.  After  the 
amalgam  has  hardened  the  filling  should  be  polished, 
so  that  no  rough  surfaces  are  left  to  catch  food 
particles. 

CEMENT  FILLINGS.— Cement  fillings  are  used 
mostly  for  temporary  work,  and  in  children's  teeth 
where  permanent  work  cannot  be  done. 

Many  people  speak  of  these  fillings  as  ''bone"  fill- 
ings, but  such  is  not  the  case.  However,  there  are 
many  places  where  a  cement  filling  is  preferable  to  any 
other,  and  often  it  is  used  for  a  permanent  filling. 
Where  decay  is  extensive,  and  all  the  decay  cannot  be 
removed,  often  a  copper  cement  is  used,  because  of  its 
germicidal  effect  on  decay  left  in  the  tooth.  Or  an  or- 

—92— 


FILLING    AND  TREATING   TEETH 

dinaiy  cement  filling  may  be  used  because  the  tooth 
wall  not  tolerate  a  metal  filling. 

Metal  is  a  conductor  of  heat  and  cold,  especially  the 
silver  metal  used  in  filling  teeth,  and  the  pulp  may  die 
from  the  repeated  shocks,  from  heat  and  cold,  caused 
by  hot  or  very  cold  food  taken  into  the  mouth.  Cement 
does  not  conduct  heat  or  cold  as  well,  and  is  often 
used  where  the  tooth  is  very  sensitive.  If  the  cement 
dissolves  it  can  be  replaced.  This  is  better  than  to 
have  the  pulp  die  and  to  have  the  root  canals  filled. 

The  principal  objection  to  cement  is  that  it  may 
dissolve  from  the  cavity.  Cement  will  stay  in  cavities 
in  one  patient's  mouth  for  long  periods  of  time,  and 
in  some  other  person's  mouth  will  last  only  a  short 
time.  This  is  not  entirely  due  to  the  cement,  but  to  the 
conditions  in  the  mouth.  SYNTHETICS.- 

Among  the  re- 
cent cements  put 
on  the  market  are 
the  so  called  Syn- 
thetic porcelains, 
'ma  or  artificial  enamel 
™  cements.  These  are 
made  in  many 
shades  or  colors  to 

Figure  XIV.    Photograph  of  child's  teeth,    match     the     differ- 
aa:e  13  vears.  The  dark  spots  show  where  x        i         j  -e 

.,     1     "    ,      ,  4.     /      1    ^     ^,1-        ent   shades    ot 

the  decay  lias  been  cut  out  ready  for  Tilling. 

teeth. 
These  cements  are  more  permanent,  and  have  to  a 
great  extent  replaced  the    use    of    gold    fillings    and 

—93— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

porcelain  inlays  in  the  front  teeth.     Cavities  can  Be 
filled  with  this  Synthetic  porcelain,  and  the  fillings 

matched  up  with 
the  color  of  the 
tooth  so  that  the 
filling  cannot  be 
detected,  except  by 
very  close  exam- 
ination. 

This  is  also  used 
in  the  teeth  furth- 

Figure  XV.  The  teeth  shown  in  Figure  14  ^^  ^^^^^  ^^^^  makes 
iilled   with   a  material  like  the   enamel   of 

the  natural  teeth.   This  looks  better  than  ^^        ideal        filling 

^old,  and  restores  the  natural  appearance,  where     it     Can     be 

properly  placed,  and  does  away  with  unsightly  metal 
fillings  in  the  mouth. 

TREATING  TEETH.— When  a  tooth  has  decayed 
so  that  the  pulp  is  exposed,  the  pulp  will  have  to  be 
removed,  and  the  root  canals  cleaned,  sterilized  and 
filled,  so  that  no  moisture  or  septic  matter  can  enter 
from  the  root  end  of  the  tooth.  The  vitality  of  the 
pulp  or  nerve  may  be  destroyed  by  applying  a  devital- 
izing paste  to  it,  and  sealing  the  opening  of  the  cavity 
with  cement.  In  a  few  days  the  treatment  can  be  re- 
moved, and  the  pulp  taken  out  of  the  root  canal  without 
-any  pain.  Or  a  rubber  cloth  may  be  placed  over  the 
tooth,  and  a  local  anesthetic  applied  by  means  of 
pressure,  and  within  a  few  minutes  the  pulp  can  be 
removed  without  hurting.  If  plenty  of  time  is  taken 
for  the  treatment  there  will  be  no  pain.  Pain  is  gen- 

—94— 


FILLING  AND  TREATING  TEETH 

erally  the  result  of  too  much  hurry.  The  proper  treat- 
ment and  fining  of  the  root  canals  in  teeth  is  one  of  the 
most  important  parts  of  dental  work.  The  good  health 
of  the  tooth  treated  depends  on  the  stability  of  the 
root,  and  if  the  work  is  well  done  the  tooth  will  be 
useful.  If  it  is  not  well  done  an  alveolar  abscess,  or 
*'gum-boil,"  will  result,  which  will  very  likely  cause  the 
loss  of  the  tooth,  and  may  cause  more  serious  trouble. 

After  the  pulp  has  been  removed,  the  canals  cleaned 
and  sterilized,  some  inert  substance  is  introduced  into 
the  canals  and  worked  up  to  the  end  of  the  root,  com- 
pletely sealing  the  opening  against  the  entrance  of  anjr 
moisture  or  infection  from  the  tissues  at  the  end  of 
the  root. 

A  tooth  with  a  live  pulp  is  more  durable  than  one 
in  which  the  pulp  has  been  destroyed.  Therefore,  it 
is  best  to  have  all  decayed  places  repaired  before  the 

decay  gets  too  deep  and  exposes  the 
pulp,  but  after  it  is  exposed  it 
must  be  treated,  and  too  much 
care  and  skill  cannot  be  used  ia 
the  operation.  Many  people  think 
that  all  that  is  necessary  is  to 
*'kill  the  nerve",  and  let  it  go  with- 
Fig.  XVI.  Left  tooth    o^t  fliij^g  the  root,  but  if  this  is 

perfectly    filled    root.  i  •   i 

Right    tooth    imper-    done,  an  abscess  will  result  which 
fectiy  filled  root.  forms  pus,  and  this    is    absorbed 

into   the   system,    and   may   set   up   a   more   serious 
disturbance.    If  a  faulty  root  canal  filling  is  made,  an 

—95— 


'-#^r 


Pigure  X^^II.      Shows   eyes   of  patient  with   severe 

iritis  due  to  a  dental  abscess. 

Courtesy   Dr.    Thomas    B.    Plartzell, 

College    of   Dentistry,    University    of    Minnesota. 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

abscess 
will  form. 
Abscesses, 
or  ''g  u  m- 
boils,"  dis- 
charge pus 
which  is 
mixed  with 
food  and 
saHva  and 
swallowed, 
produc- 
ing digest- 
i  V  e  d  i  s- 
turbances. 

This  pus  is  also  taken  up  by  the  blood  current  and 
lymphatics,  and  carried  to  remote  parts  of  the  body, 
where  inflamatory  lesions  are  caused,  such  as  in  the 
joints,  muscles,  eyes  or  appendix. 

Abscesses  on  the  gums  constantly  discharge  pus. 
This  not  only  causes  the  mouth  to  have  a  foul  odor,  but 
allows  the  food  to  be  mixed  with  this  pus  and  swallow- 
ed, thus  affecting  the  entire  digestive  system,  as  well 
as  carrying  infection  to  other  organs.  Such  people 
usually  suffer  from  neuralgia,  rheumatism  and  like 
diseases. 

Figure  17  shows  a  severe  case  of  iritis  caused  by  a 
Cental  abscess  involving  the  left  antrum.  Extraction 
of  the  tooth  and  cleaning  of  the  tooth  sockets  resulted 

—96— 


FILLING  AND  TREATING   TEETH 

in  a  rapid 
imp  rove- 
m  e  n  t  of 
the  inflam- 
mation o  f 
the  eyes. 
M  Figure  18 
shows  veg- 
etation on 
the  valves 
of  the 
heart  of  a 
patient 
who  had  a 

Fiaure    X\'III.    Sliows    veuetation     on    tlie    mitral  „ 

valves    of    Iieart.       I'atient    who    liad    several    dental    number     01 

abscesses. 

Courtesy  Dr.  Tlionias  l?.  Hartzell, 

Colleiie    of    Dentistry,    l^niversit\'    of    Minnesota. 


dental    ab- 
scesses. 


In  Figure  19  an  X-Ray  picture  is  shown  of  a 
man's  hand,  who  suffered  from  a  form  of  rheu- 
matism, called  arthiitis  deformans,  caused  by  dental 
abscesses. 


The  infection  was  carried  to  the  joints,  resulting  in 
the  deformity.  These  pictures  have  been  presented  to 
show  the  danger  which  may  result  from  neglected  ab- 
scesses. 

Too  much  care  cannot  be  given  to  the  filling  of  the 
root  canals  of  treated  teeth.  Besides  the  danger  of  ab- 
scesses from  badly  treated  teeth,  the  person  will  have 
a  very  foul  breath,  and  become  disagreeable  to  others 

—97— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


in  social  and 
business  in- 
terco  u  r  s  e, 
B  us  i  nes  s- 
and  social 
success  de- 
pend much 
on  good 
health,  and 
a  good  per- 
s  0  n  a  1  a  p- 
p  e  a  r  a  n  c  e 
c  o  n  t  r  i  b- 
utes  greatly 
to  a  favor- 
able impression  in  any  walk  of  life.  Unsightly  teeth 
often  spoil  the  looks  of  an  otherwise  good  looking  per- 
son, while  in  some  other,  the  even,  well  cared  for  teetk 
give  that  individual  a  pleasant  appearance,  that  often 
creates  the  favorable  impression  which  insures  success 
in  business  and  social  undertakings.  Bad  teeth  are  a. 
source  of  ill  health  and  retard  the  individual  in  any 
work. 


Figure  XIX.  Shows    X-Ray    of    hand    of    man 

suffering    from     arthritis    deformans,     a     form    of 

rlieumatism  due  to  dental  abscesses. 

Courtesy  Dr.  Thomas  B.  Hartzell, 
College    of    Dentistry,    University    of    Minnesota. 


—98— 


CROWN  AND  BRIDGE  WORK. 

CHAPTER  VII. 

When  teeth  become  so  badly  decayed,  or  are  broken 
off,  so  that  they  cannot  be  filled,  it  becomes  necessary 
lo  crown  them  in  order  that  their  usefulness  may  be 
Testored.  Often  teeth  have  been  extracted  and  a 
space  left,  giving-  an  unsightly  appearance,  and  de- 
stroying the  continuous  chewing  surface  necessary  to 
good  mastication  of  the  food.  In  such  cases  these 
spaces  are  often  filled  in  by  bridge  work,  the  appear- 
ance bettered,  and  the  masticating  surface  of  the  teeth 
Testored. 

Sometimes,  in  bridge  work,  it  is  necessary  to  use  a 
sound  tooth  for  the  attachment  of  the  support  crown. 
In  such  cases  it  is  usually  best  to  preserve  the  vitality 
of  the  tooth.  The  pulp  should  not  be  removed  from 
such  a  tooth  if  there  is  any  way  to  avoid  it,  but  where 
j^ront  teeth  are  to  be  crowned,  it  is  usually  best  to  re- 
move the  pulp  or  "nerve",  and  restore  the  appearance 
by  the  use  of  a  porcelian  faced  crown,  because  gold 
crowns  do  not  make  a  good  appearance  where  they 
show  in  the  front  of  the  mouth. 

Teeth,  in  which  it  becomes  necessary  to  remove  the 
pulp,  should  be  carefully  treated,  to  prevent  abscesses 
forming   later  and    causing    the    loss    of    the    teeth. 

—99— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

Should  this  happen,  the  entire  bridge  might  be  lost.  If 
the  supporting  teeth  become  diseased,  the  crowns- 
will  have  to  be  removed.  It  can  readily  be 
seen  that  the  teeth  must  have  sound,  healthy 
roots,  in  order  to  support  crowns  or  pieces  of  bridge 
work.  If  the  foundation  fails,  the  top  structure  will 
also  fail. 

The  X-Ray  is  of  great  use  to  the  dentist,  for  by  it 
he  can  tell  how  well  a  root  canal  has  been  filled. 
Wherever  possible,  an  X-Ray  of  the  treated  tooth, 
whether  for  crown  or  bridge  work,  or  for  ordinary 
filling,  should  be  taken.  A  root  canal  is  a  blind  pass- 
age, and  hard  to  fill  under  the  best  conditions.  Single 
rooted  teeth  are  comparatively  easy  of  access,  but  mul- 
tiple rooted  teeth,  like  the  molars,  are  very  difficult  to 
fill. 

After  the  root  treatment  has  been  properly  done, 
the  next  step  is  to  see  that  the  crown  is  properly  pre- 
pared, and  that  in  this  preparation  no  injury  be  done 
the  gum  and  delicate  membrane  surrounding  the  tooth 
root,  which,  if  injured,  may  cause  disease  in  this  deli- 
cate tissue,  and  the  previous  good  work  lost. 

It  is  the  purpose  of  modern  artificial  crown  and 
bridge  work  to  restore  the  broken  teeth  to  usefulness, 
and  to  make  them  as  near  indistinguishable  from 
natural  teeth  as  possible.  To  do  this,  as  little  gold 
should  be  exposed  to  view  as  possible.  There  are  vari- 
ous ways  to  restore  broken  down  teeth  by  crowns, 
some  of  which  will  be  briefly  described. 

THE     PORCELAIN     CROWN.— Porcelain    ready- 

—100— 


CROWN  AND  BRIDGE  WORK 


is- 

o 

P-i 

O 

l-H 

tj 

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r  "1 

«<-i 

X 

v-> 

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_CJJ 

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Ph 

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o 


^101— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


made  crowns  are  made  in  many  shades  and  sizes,  and 
make  an  ideal  restoration  for  front  teeth,  as  the  exact 
size  and  color  can  be  obtained  for  any  ordinary  case. 
These  crowns  are  made  for  the  ten  teeth  in  the  front 
of  the  mouth,  namely,  the  four  Incisors,  the  two  Cus- 
pids, and  the  four  Bicuspids,  either  for  the  upper  or 
lower  set  of  teeth. 

The  crown  is  made  of  porcelain,  with  a  post  or  pin 
baked  in  when  the  crown  is  made.  It  restores  the 
tooth  to  its  natural  appearance,  and  no  gold  or  other 

metal  is  ex- 
posed    to 

•  view. 

•  The  prop- 
er   c  o  1  0  r 

• 

'  and  size  of 

^  the     crown 

is    selected 

.  and  ground 

:.to    fit    the 

\  i'oot,    after 

:  which     the 

1  post  of  the 

crown   is 

c  e  m  e  n  ted 

to  the  root. 

This  crown 

restores  the  natural  appearance,  the  contour  or  shape  of 
the  tooth,  and  is  strong  enough  to  stand  severe  use.  It 
is  clean,  and  is  easily  adapted  and  attached  to  the  root. 

—102— 


Figure  XXII. 
Porcelain  Crown  Completed 


CROWN  AND  BRIDGE   WORK 

A  well  selected  and  well  placed  crown  of  this  kind 
cannot  easily  be  noticed,  except  by  very  close  observa- 
tion, and  often  not  then,  by  the  average  person. 

Figure  20  shows  the  photograph  of  a  tooth,  badly 
decayed,  which  needs  a  crown.  A  porcelain  crown 
will  be  suitable,  and  will  make  a  nice  restoration. 

In  Figure  21  a  photograph  is  shown  where  the  tooth 
root  has  been  prepared  to  receive  the  crown.  The  pulp 
has  been  removed  and  the  root  canal  filled.  The  tooth 
is  then  cut  off  even  with  the  gum.  This  causes  no  pain, 
for  the  ''nerve"  is  out  of  the  tooth.  The  crown  is  then 
ground  to  fit  the  root  and  cemented  into  place. 

Figure  22  shows  appearance  of  the  completed  crown. 

THE  RICHMOND  CROWN.— In  many  places  the 
ready-made  porcelain  crown  cannot  be  used  because 
of  a  frail  root  support.  The  root  might  be  fractured 
by  the  great  leverage  exerted  on  the  root  by  the  pin,, 
where  no  band  or  brace  supports  it.  In  this  case  a 
band,  with  a  cap,  is  made  for  the  top  of  the  root,  and 
a  pin  run  through  the  cap  into  the  root  canal,  and  the 
pin  and  the  cap  soldered  together;  or  the  entire  cap 
may  be  cast  in  gold,  much  like  a  gold  inlay.  A  porce- 
lain facing  with  a  backing  of  metal  to  support  it,  is 
selected  and  ground  to  fit,  after  which  gold  solder  is 
used  to  fuse  the  parts  together.  This  makes  a  crown 
with  the  appearance  of  a  porcelain  tooth,  with  a  band 
around  the  root  to  prevent  fracturing,  and  a  gold  back 
to  strengthen  the  tooth  and  prevent  breaking.  How- 
ever, should  the  porcelain  facing  become  broken  at 
any  time,  it  can  easily  be  replaced  without  removing 

—103— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


the  rest  of  the  crown.  This  is  accomplished  by  the  use 
of  an  interchangeable  facing  which  is  cemented  to  the 
metal  backing.  It  makes  a  clean,  strong  crown,  and 
restores  the  natural  appearance. 

The  following  illustration  shows  the  way  such  a 
crown  is  made  and  the  appearance  of  the  crown  when 
made.  Figure  XXIII. 

THE  GOLD  COL- 
LAR CROWN.— 
This  kind  of 
crown  is  made  of 
plate  or  sheet  gold 
or  platinum.  The 
natural  crown  is 
ground  down  so 
that  the  sides  of 
the  tooth  are  par- 
allel, and  the  top  of  the  tooth  ground  so  there  will  be 
a  space  left  between  it  and  the  opposing  teeth  in  the 
opposite  jaw,  for  the  gold  cap.    The  root  is  measured 

at  the  gum,  and  a 
band  is  made  to  fit 
snugly  around  it 
and  down  to  the 
gum;  after  which 
a  cap,  made  with 
cusps  in  the  form 

Figure   XXIV.  ^  ,  , 

Gold   Shell   Crown.  ^^      ^      natural 


Fi.uTire  XXIII. 
Itichiuond  Crown. 


-104— 


CROWN  AND  BRIDGE  WORK 

crown  is  soldered  to  the  band,  to  enclose  the  tooth,  and 
the  crown  cemented  to  the  root.  Or  the  entire  crown 
may  be  made  of  one  seamless  piece  of  gold,  by  swag- 
ing or  stamping  with  a  die. 

Both  the  gold  collar  crown  and  the  Richmond  crown 
are  used  extensively  as  supporting  crowns  for  bridge 
work. 

Figure  24  represents  a  broken  down  tooth,  the  way 
the  root  is  prepared  for  the  crown,  and  the  completed 
crown  cemented  into  place. 

PARTIAL  CROWNS.— Where  teeth  are  abraded 
or  worn  off,  solid  gold  inlays  may  be  cast  and  attach- 
ed to  the  teeth.  This  will  raise  the  ''bite"  and  keep 
the  teeth  from  wearing  off  down  to  the  gums. 

In  pulpless  teeth  the  decay  may  have  destroyed 
most  of  the  crown  of  the  tooth,  and  yet  left  it  solid 
around  the  gum.  Inlays  may  be  cast  for  these  teeth, 
and  when  cemented  into  place  restore  the  usefulness 
and  good  appearance  of  the  teeth,  avoiding  the  use  of 
an  artificial  crown. 

BRIDGE  WORK. — Bridge  work  has  many  advan- 
tages when  made  by  an  expert  who  properly  con-^ 
structs  and  puts  it  into  place.  But  most  people  expect 
too  much  of  bridge  work,  and  in  many  cases  it  is  much 
abused  and  failures  result. 

ITS  ADVANTAGES  ARE :— That  it  is  immovably 
cemented  into  place.  Lost  teeth  can  be  perfectly  re- 
placed" by  it  without  the  use  of  a  plate.  There  is  no 
mechanical  contrivance  to  hinder  articulation.  Also, 
it  is  fairly  permanent  in  character. 

—105— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

•  THE  DISADVANTAGES  ARE :— That  it  tends  to 
collect  filth  on  the  surfaces  next  to  the  gums,  and 
causes  a  bad  odor  in  the  mouth  if  not  constantly  cared 
for.  This  is  more  true  of  large  bridges  than  of  small 
ones.  However,  by  keeping  the  parts  brushed,  and  by 
the  regular  use  of  a  dentrifice,  the  mouth  can  be  kept 
in  a  very  satisfactory  shape. 

The  teeth  used  as  supports  are  destroyed  for  any 
other  use.  In  extensive  bridges  the  speech  and  com- 
fort of  the  patient  are  often  affected.  In  cases  where 
repairs  are  needed,  or  on  account  of  disease,  such  as 
abscesses,  it  may  become  necessary  to  remove  the 
bridge,  and  it  is  injured  and  is  unfit  for  reinsertion. 
Large  bridges  are  generally  uncalled  for.  The  teeth 
which  support  the  bridge  are  called  on  to  do  more -work 
than  nature  intended,  as  two  teeth  might  be  supporting 
a  six  tooth  bridge.  This  would  be  making  one  tooth  do 
the  work  of  three  teeth.  As  one  man,  doing  the  work 
of  three  men,  m^ight  break  down  under  the  strain,  so 
the  teeth  will,  if  too  much  work  is  put  upon  them. 

Bridge  work  properly  constructed  will  be  satisfac- 
tory. Its  advantages  have  the  endorsement  of  a  ma- 
jority of  the  dental  profession,  and  patients  who  are 
wearing  well  constructed  bridge  work  could  not  be  in- 
duced to  get  along  without  it.  It  is  much  more  ex- 
pensive than  plate  work,  but  by  it  teeth  can  be  pre- 
served and  made  useful,  which  otherwise  would  have 
to  be  extracted. 

CONSTRUCTION  OF  BRIDGE  WORK.— Consid- 
eration should  be  given  to  the  amount  of  strain  that 

—106— 


CROWN  AND  BRIDGE   WORK 


can  be  borne  by  the  different  teeth,  and  their  condi- 
tion of  health.  Generally  speaking  the  best  results 
are  obtained  where  only  small  bridges  are  worn,  es- 
pecially those  made  to  replace  bicuspid  and 
molar  teeth.  The  two  cuspids,  which  are  the 
largest  and  strongest  rooted  teeth  in  the  mouth, 
will  usually  support  a  six  tooth  bridge  to  re- 
store the  six  front  teeth,  especially  in  the  up- 
per   jaw. 

Below  is  given  a  series  of  illustrations  showing  the 
construction  of  a  six  tooth  bridge,  from  the  upper 
right  central  incisor  to  the  first  molar. 

Fig.  25  shows 

\  a  plaster  cast  of 

■f  the  upper  right 

side  of  the  jaw^ 

^       I     with  three  teeth 

^    ,  I    missing,     and 


%ijri»^ 


Figure  XXV. 
Courtesy    of    Columbus    Dental    M'f'g.    Co 


three  teeth  de- 
cayed. 

Figure  26  shows  the  next  step  in  preparation.    The 

molar  tooth  has 
been  trimmed 
down  for  a  gold 
B  h  e  1  1  crown. 
The  cuspid  and 
the  central  in- 
cisor have   been 


Figure  XXVI. 
Courtesv   of   Columbus   Dental   M'fg. 


Co. 


cut  off  and  made  ready  for  a  Richmond  crown. 

—107— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


Figure   27   shows   the   gold   crown   for   the   molar 

tooth,  and  the 
caps  for  the  cus- 
pid and  central 
incisor,  set  on 
the  model,  ready 
to  replace  mis- 
sing teeth. 

Figure  2  8 
shows  the  miss- 
ing spaces  fill- 
ed in,  and  the 
case  set  up  for 
soldering  the 
parts     together. 


Figure  XXVII. 
Courtesv    of    Columbus    Dental    M'f'a:.    Co. 


Figure  XXVIII. 
Courtesy   of    ColuniVjus   Dental    M'f'g.    Co. 


Figure  29  shows  the  bridge  fastened  together.    The 

gold  backings  and  t>ip 
crowns  are  fastened  or  fused 
together  with  gold  solder. 
Figure  30  shows  the  bridge 
Fig^ure  XXIX.  ^.-^j^    ^^^    facings    attached 

Courtesy  ot   Columbus  Dental 

Manufacturing  Co.  and  Cemented  to  place.  These 

facings  are  easily  replaced 
if  any  of  them  should  be- 
come broken,  and  the  repairs 
can  be  made  in  a  few  min- 
utes, without  having  to  re- 
move or  damage  the  bridge. 


Figure   XXX. 

By  Courtesy  of  the  Columbus 
Dental     Manufacturing    Co. 


—108— 


CROWN  AND   BRIDGE  WORK 


Figure  31    shows  a  three  tooth  bridge  in  place,    in 
the  mouth.    This  makes  an  ideal  piece  of  work  to  re- 
place  missing   teeth.     It   is   clean    and    sanitary,    re- 
stores     the      masticating 
surface    of    the    missing 
teeth,    and   improves  the 
personal  appearance.      It 
restores  the  teeth  without 
the   use   of   a   plate,    and 
aids  in  restoring  speech, 
for  where  teeth  are  miss- 
,_      ,  '    ing    speech    is    often    in- 

Fiiiurc  xxxT.  terferred  with. 

THE  CARE  OF  CROWNS  AND  BRIDGE  WORK. 
— Where  bridge  work  or  crowns  are  worn,  careful  at- 
tention should  bo  given  the  mouth  to  keep  it  clean,  and 
the  artificial  parts  free  from  food  particles  which  tend 
to  lodge  there,  and  which  decay  and  cause  the  breath 
to  be  foul.  After  every  meal  the  teeth  should  be  well 
l3rushed  and  rinsed  with  water. 

It  must  be  remembered  that  the  tissues  of  the  mouth, 
•especially  the  delicate  gums  around  the  teeth,  are  easily 
injured.  If  filth  is  allowed  to  accumulate,  the  gums  will 
recede  or  pull  back  from  the  crowns,  the  roots  of 
the  teeth  becom.e  diseased  and  loosened,  and  the  den- 
tal work  will  be  lost.  The  foundations  of  the  parts 
must  be  kept  healthy  to  insure  the  permanence  of  the 
work. 


—109— 


CARE  OF  THE  TEETH  AND  MOUTH. 

CHAPTER  VIII. 

The  care  of  the  mouth  should  begin  when  the  child 
is  young.  The  mother  should,  as  soon  as  the  first  teeth 
appear,  cleanse  each  tooth  with  a  piece  of  soft  linen 
or  cotton  cloth,  wiping  off  all  accumulations,  keeping- 
the  teeth  polished  well  at  all  times.  By  the  time  the 
child  is  two  or  three  years  old  he  should  be  able  to  use 
a  tooth  brush  and  keep  his  own  teeth  clean. 

A  child  will  soon  learn  the  pleasure  of  a  clean  mouthy 
and  will  usually  be  willing  to  continue  cleaning  his 
teeth.  If  neglectful  in  doing  this,  often  rewards  will 
stimulate  renewed  effort. 

The  health  of  the  child  is  greatly  influenced  by  con- 
ditions in  the  mouth  during  the  first  five  or  six  years- 
of  life,  and  if  conditions  are  very  bad,  the  influence 
will  be  felt  throughout  the  life  of  the  adult.  There- 
fore, the  importance  of  keeping  the  mouth  clean  and 
free  from  food  remnants  and  tartar,  should  be  learned 
by  every  one,  and  the  earlier  this  is  learned  the 
better  for  the  individual. 

Practically  all  dental  troubles  come  from  uncleanli- 
ness. 

Children  attending  school  eat  candies  and  sweets^ 
and  leave  the  teeth  covered  with  particles  of  it,  whick 
soon  ferment  when  lodged  in  the  pits  of  the   crowns- 

—110— 


CARE  OF  THE  TEETH  AND  MOUTH 

and  between  the  teeth.  Perhaps  food,  such  as  cakes 
and  sandwiches,  are  taken  to  school  for  kincheon,  and 
the  food  remnants  are  also  left  on  the  teeth. 

Besides  decay  being  caused,  the  food  accumulating 
around  the  teeth  will  cause  bad  odors,  and  the  mouth 
will  be  in  a  filthy  condition.  If  the  teeth  are  brushed 
clean  after  eating  candy,  or  after  each  time  food  is 
€aten,  no  harm  will  result. 

TARTAR. — Tartar  is  composed  of  mineral  and  ani- 
mal matter,  deposited  from  the  saliva  and  food. 
Sometimes  the  teeth  are  entirely  covered  with  and 
stained  by  it.  In  young  children  it  may  commence  as 
a  green  stain.  In  older  persons  it  may  be  dark,  yellow, 
or  sometimes  of  a  whitish  color,  depending  on  the  con- 
ditions causing  it. 

These  deposits  press  against  the  gums  and  crowd 
"them  away  from  the  roots  of  the  teeth,  and  soon  bac- 
teria enter  and  pus  pockets  form.  Pyorrhea  has  now 
begun,  and  if  let  go  on,  the  teeth  are  soon  loosened,  and 
in  time  lost. 

EFFECTS  OF  TARTAR.— It  causes  the  gums  to  be- 
come soft  and  spongy,  and  they  bleed  at  every  little 
injury.  Pus  is  also  formed,  as  stated  before,  and  the 
food  eaten  is  mixed  with  this  pus,  which,  passing  in- 
to the  stomach,  impairs  the  entire  digestive  system. 

Not  only  remote  parts  of  the  body  are  affected  di- 
2'ectly,  but  the  parts  adjacent  to  the  mouth  — the  ton- 
sils, nose,  the  ears,  through  the  Eustachian  tube,  and 
even  the  eyes,  as  shown  in  a  previous  chapter. 

The  way  to  avoid  all  this  discomfort  and  danger  is  to 

—111— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

keep  the  mouth  scrupulously  clean  and  free  from  de^ 
caying  food,  thus  preventing  all  deposits  from  forming 
on  the  teeth.  This  demands  the  most  constant  attention.. 

In  one  who  has  practiced  keeping  the  mouth  clean,, 
it  is  comparatively  easy  to  keep  all  deposits  brushed 
from  the  teeth.  If  deposist  are  once  allowed  to 
form  on  the  teeth,  no  one  but  the  dentist  can  ckan 
them  thoroughly.  This  is  because  no  one  can  see  just 
where  the  deposits  are,  or  be  able  to  use  the  proper  in- 
struments to  remove  them  from  his  own  mouth  with- 
out doing  some  injury  to  the  soft  tissues. 

After  deposits  are  removed  from  the  teeth,  patients 
often  complain  that  the  teeth  are  very  sensitive,  es- 
pecially to  hot  and  cold  substances.  This  is  natural, 
for  the  tartar  has  crowded  the  gum  back  from  the 
roots  of  the  teeth,  and  replaced  the  natural  gum  cov- 
ering the  root.  The  root  of  the  tooth  has  no  enamel  to 
protect  it,  and  when  the  tartar  is  removed,  the  sensi- 
tive root  is  exposed,  and  is  easily  irritated  by  hot  and 
cold  foods.  This  will  not  last  long,  however,  for  the 
gums  will  partly  return  over  the  roots,  and  the  teeth- 
will  soon  adjust  themselves  to  the  clean  condition. 

Teeth  which  are  allowed  to  become  very  foul  usual- 
ly have  more  or  less  decay,  and  when  these  deposits 
are  removed  the  decayed  places  are  exposed,  and  are 
noticed  by  the  patient.  The  dentist  has  not  '"picked"' 
these  holes  in  the  teeth.  He  has  only  cleaned  the  teeth 
so  that  the  decayed  places  can  be  found.  No  dentist 
would  do  such  a  thing,  nor  would  a  responsible  dentist; 
use    medicine    or    instruments    that    would     do    any^ 

—112— 


CARE  OF  THE  TEETH  AND  MOUTH 

damage  to  the  teeth.  Enamel  is  too  hard  to  be  easily 
damaged  by  the  fine  instruments  used  to  clean  teeth. 
It  is  difficult  to  penetrate  enamel,  sometimes,  with  a 
dental  bur ;  therefore,  the  delicate  dental  instruments 
will  do  no  damage. 

THE  EFFECT  OF  FOOD  ON  THE  TEETH.— The 
different  kinds  of  food  and  drink  have  their  effect  on 
the  teeth.  Very  hot  foods  are  liable  to  injure  the 
enamel,  as  also  are  very  cold  ones.  Many  people  will 
take  very  hot  food  into  the  mouth,  and  then  take  a 
drink  of  cold  water  or  iced  tea.  This  rapid  change 
from  hot  to  cold  often  causes  the  enamel  to  crack. 
Heat  expands  and  cold  contracts.  The  hot  food  will 
expand  the  tooth  substance,  and  if  cold  is  applied  sud- 
denly the  contraction  is  too  rapid,  and  causes  the  tiny 
little  fractures  often  seen  in  the  teeth,  especially  in 
the  front  teeth.  This  is  also  true  of  sudden  changes 
from  cold  to  hot  foods.  The  principle  on  which  this 
damage  is  done  can  easily  be  shown  by  placing  a  glass 
tumbler  in  cold  water,  and  then  quickly  placing  it  in 
hot  water.  The  rapid  change  in  expansion  will  crack 
the  glass.  This  is  what  happens  to  the  enamel  of  the 
tooth.  Often  these  little  cracks  may  be  caused  by 
blows  on  the  teeth,  but  usually  it  is  from  the  abuse  of 
hot  and  cold  substances  in  the  mouth. 

'The  prepared  foods,  much  in  use  to-day,  help  cause 
many  dental  troubles.  The  great  amount  of  white  bread 
eaten  is  a  factor  in  dental  decay.  Soft  food,  requiring 
little  chewing,  is  swallowed  without  being  properly 
chewed.  The  teeth  and  gums  do  not  get  enough  exercise. 

—113— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


Whole  wheat  bread  and  some  of  the  other  coarse 
breads   are  good  for  the  teeth,   because  they   require 

more  chewing  to  prepare  them  for 
swallowing.  Thus  the  teeth  and 
gums  are  given  more  exercise,  and 
are  cleaned  better. 

Apples  and  fibrous  vegetables 
cleanse  the  teeth  well  and  give 
plenty  of  exercise. 

Chewing  gum  helps  clean  the 
teeth  and  keep  the  gums  in  good 
condition.  Unsweetened  gum  is 
the  best  to  use.  If  a  sweetened 
gum  is  used,  the  teeth  should  be 
well  brushed  afterward.  However, 
the  place  to  chew  gum  is  not  in 
public  places,  but  rather  in  the 
privacy  of  the  home. 

If  any  deposits  are  allowed  to 
collect,  chewing  rough  foods  and 
gum  will  not  remove  the  deposits. 

The  teeth  should  be  brushed 
after  each  meal,  and  the  gums 
thoroughly  massaged,  and  the 
tongue  should  not  be  neglected  in 
this  cleaning  process.  When  a 
person's  tongue  is  inclined  to  be 
coated,  a  tongue  scraper  may  be 
used  to  clean  the  tongue  and  help 
keep  the  mouth  in  clean  condition. 

—114— 


Figure  No.  XXXII. 
A  Tongue   Scraper. 


CARE  OF  THE  TEETH  AND  MOUTH 

CLEANING  THE  TEETH.— The  teeth  should  be 
brushed  frequently,  and  the  mouth  kept  free  from 
debris  at  all  times.  The  ideal  way  to  care  for  the  teeth 
is  to  brush  them  with  a  suitable  brush  and  luke  warm 
water,  in  the  morning  before  eating  breakfast.  This 
cleans  the  mouth,  so  that  the  food  eaten  will  be  mixed 
with  clean  saliva,  and  there  will  be  no  secretions  from 
over  night  left  on  the  teeth  to  be  mixed  with  the  food, 

As  soon  as  the  meal  is  over,  the  teeth  should  be 
brushed  again,  to  remove  food  particles.  At  this  time 
a  tooth  powder  may  be  used,  or  luke  warm  water. 
Some  people  like  to  use  a  little  salt  in  the  water  when 
brushing  the  teeth,  which  helps  harden  the  gums  and 
imparts  a  sense  of  cleanliness  to  the  mouth.  Others 
make  a  practice  of  cleaning  the  mouth  and  teeth  before 
and  after  each  meal,  and  this  might  be  called  the  ideal 
way.  Few  of  them  ever  suffer  from  disease  of  the 
mouth  or  decay  of  the  teeth,  provided,  of  course,  that 
cleanly  habits  were  practiced  before  decay  began. 

Dental  floss  should  be  run  between  the  teeth 
occasionally,  to  keep  the  spaces  between  the  teeth 
clean.  This  can  be  purchased  at  the  drug  store,  or 
your  dentist  will  supply  you.  A  piece  about  six  inches 
long  is  held  taut  and  passed  between  the  teeth.  Care 
should  be  used  not  to  let  it  slip  down  on  the  gum  and 
cut  it.  Hold  the  piece  of  silk  floss  taut,  one  end  in  each 
hand,  and  gently  work  it  between  the  teeth,  taking 
them  in  rotation.  The  silk  floss  is  waxed,  and  will  easi- 
ly pass  between  the  teeth  without  cutting,  except 
where  there  is  a  cavity  between  the  teeth.    If  there  is  a 

—115— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

cavity  the  floss  will  be  frayed  or  cut.  Even  when  decay 
has  begun  it  will  be  retarded  and  kept  from  spreading 
as  much  as  it  would  do  if  the  mouth  were  unclean. 

A  good  tooth  powder  should  be  used  once  a  day. 
Some  teeth  are  even  and  regular,  and  so  set  in  the 
arches  that  it  is  an  easy  matter  to  keep  them  clean. 
People  with  such  teeth  have  little  trouble  keeping  them 
in  good  condition.  On  the  other  hand,  there  are  others 
who  have  irregular  teeth,  or  have  some  of  them  miss- 
ing ;  there  may  be  crowns  or  bridge  work,  or  a  partial 
plate.  These  patients  have  more  or  less  trouble  keep- 
ing the  mouth  clean  and  wholesome. 

Each  person  should  consult  his  dentist,  and  get  ad- 
vice in  regard  to  cleaning  the  teeth;  how  often  to  do 
this;  the  kind  of  powder  or  dentrifice  to  use;  and  the 
best  way  to  do  the  brushing.  A  doctor  does  not  give 
the  same  kind  of  medicine  to  all  his  patients.  He  finds 
out  what  the  trouble  is,  and  prescribes  for  each  case. 
This  is  more  or  less  true  of  the  dentist.  The  individ- 
ual needs  and  desires  of  each  patient  are  to  be  con- 
sidered, and  your  family  dentist  will  be  the  one  to  ad- 
vise you  best.  It  will  be  time  and  money  saved  to  seek 
this  advice.  Few  people  have  the  knowledge  to  select 
proper  brushes  and  cleaning  agents  for  themselves. 
There  are  many  kinds  of  tooth  brushes,  powders, 
pastes  and  mouth  washes  on  the  market,  and  while 
many  of  them  are  good,  there  are  also  many  of  them 
that  are  not  good,  and  some  of  them  are  worse  than 
useless,  because  they  injure  the  teeth  and  the  tissues 
of  the  mouth.  Some  of  these  powders,  pastes  or  washes 

—116— 


CARE  OF  THE  TEETH  AND  MOUTH 

contain  acids.  Acids  have  a  great  affinity  for  the 
mineral  salts,  which  make  up  a  great  part  of  the  tooth 
substance,  and  abrade  or  roughen  the  teeth,  and  make 
them  an  easy  prey  to  decay. 

Many  of  the  dental  preparations  are  put  up  in 
attractive  packages,  the  contents  sweetened  or  colored 
to  make  them  pleasing  to  the  palate  or  eye.  This 
makes  the  use  of  sugars  and  dyes  necessary  in  their 
manufacture.  Sugars  left  in  the  mouth  undergo  chem- 
ical changes,  and  an  acid  is  formed.  As  for  the  color- 
ing agents  used  in  some  pastes  and  powders,  it  has 
been  found  that  they  often  have  a  bad  influence  on  the 
teeth  and  tissues  of  the  mouth.  As  a  rule  a  good  tooth 
powder  is  better  to  use  than  any  other  cleansing  agent. 
Pastes  and  mouth  washes  are  of  doubtful  value,  for 
they  impart  a  sense  of  cleanliness  when  in  reality  the 
mouth  is  riot  clean.  If  a  paste  is  used  occasionally,  the 
mouth  should  be  well  brushed  and  rinsed  with  water 
to  remove  all  remnants  of  the  tooth  paste.  This  may 
be  advised  also  where  powder  is  used. 

Many  of  the  tooth  powders  and  creams  are  made  of 
cheap,  coarse  and  gritty  materials,  and  these  are  un- 
desirable agents  to  clean  the  teeth,  for  they  scratch 
and  wear  down  the  enamel.  The  United  States  Gov- 
ernment, through  one  of  its  Departments,  perhaps  the 
Bureau  of  Chemistry,  should  supervise  the  manufac- 
ture of  these  mouth  preparations,  and  compel  all 
manufacturers  to  come  up  to  a  certain  standard.  Such 
a  law  will  compel  many  manufacturers  to  improve 
their  products. 

—117— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

MOUTH  WASHES. — There  are  many  preparations 
made  and  sold  as  mouth  washes.  The  best  one,  how- 
ever, is  the  one  provided  by  nature.  Under  normal 
conditions  the  saliva  is  the  best  mouth  wash.  The 
teeth  are  constantly  bathed  in  it,  and  if  the  teeth  are 
kept  free  from  food  debris,  bacteria  cannot  act  on 
food  particles  between  the  teeth  and  in  the  pits  and 
grooves,  and  cause  acids  to  be  formed,  which  destroy 
the  teeth.  The  saliva  is  present  in  the  mouth  at  all 
times,  and  if  the  digestive  system  is  kept  in  good  shape 
the  general  health  will  be  good,  and  the  saliva  secre- 
tions will  be  normal.  Man  has  not  yet  succeeded  in 
producing  a  mouth  v/ash  as  good  as  the  saliva  pro- 
vided by  nature.  Water  conies  the  nearest,  and  in  sur- 
gical operations  sterilized  water  is  about  as  usefu>  as 
many  of  the  germicides  and  antiseptics  employed. 
Should  it  become  necessary  to  use  a  mouth  wash,  your 
dentist  or  physician  will  advise  you  what  to  use. 

CARE  OF  THE  TEETH.— The  baby's  first  tooth 
brush  is  usually  a  homemade  one.  A  piece  of  soft  cot- 
ton or  linen  cloth,  or  dental  cotton,  may  be  wrapped 
around  a  small  stick  or  wooden  toothpick,  or  the  finger, 
and  wet  with  a  solution  of  boric  acid,  or  bicarbonate  of 
soda.  The  little  tooth  can  be  gently  cleaned ;  also  the 
gums.  When  two  or  more  teeth  have  come  in,  a  small 
soft  brush  can  be  used  to  clean  the  teeth  and  keep  food 
particles  from  between  the  teeth. 

As  soon  as  all  the  teeth  are  in,  the  mother  should 
have  them  examined  by  the  dentist.  Often  there  are 
fissures  in  the  enamel  surfaces,  which  will  decay  if  not 

—118— 


CARE  OF  THE  TEETH  AND  MOUTH 


Fiffure   XXXIII.    Three   sizes   of   Tooth    Bruslies. 


Adult's. 


Youth's. 

—119— 


Child's. 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 


attended  to  promptly.  Usually  the  teeth  are  protected 
from  decay  if  the  surfaces  are  kept  clean.  During  and 
after  the  time  the  adult  teeth  appear,  they  should  be 
given  daily  attention,  to  prevent  decay  and  tartar 
forming.  The  teeth  should  be  brushed  at  least  once 
each  day;  once  after  each  meal  is  better. 

After  meals  a  soft  quill  toothpick  may  be  used  to 
dislodge  particles  of  food  from  between  the  teeth ;  or 
dental  floss  may  be  passed  between  the  teeth,  to  keep 
the  surfaces  between  them  polished  and  free  from  food 
particles  and  stains.  Toothpicks  should  be  used  in 
private,  not  public  places.  If  the  teeth  are  kept  clean 
they  will  not  decay. 

The  best  preventative  is  cleanliness.  Twice  a  year  is 
not  too  often  to  see  your  dentist  and  have  an  exanyn- 
ation  made  for  decay. 

*"HOW  TO  BRUSH  THE  TEETH.— Comparatively 
few  people  know  how  to 
brush  the  teeth.  Many  people 
brush  their  teeth  this  way, 
passing  the  brush  crosswise 
over    the    surface    of     the 

teeth,  thus: 

This  is  incorrect. 

Quite  a  number  of  people 
have  been  taught  to  brush 
their  teeth  this  way,  passing 
the  bristles  lengthwise  of 
the  teeth,  thus : 

—120- 


Fiffure  XXXIV  A. 


Figure  XXXIV  B. 


cleanse   the   teeth  better   than   either  1m^^^^ 
after  a  little  practice  the  user  of  this^V^ 


i3 


CARE  OF  THE  TEETH  AND  MOUTH 

This  method  is  a  great  improvement  over  the  first, 
but  is  not  thoroughly  efficacious. 

In  the  light  of  recent  investigation  conducted  at  the 
hands  of  some  of  the  leading  students  of  Mouth 
Hygiene,  the  most  effective  way  to  use  the  tooth  brush 
is  to  place  the  bristles  of  the  brush  firmly  against  the 
teeth,  applying  firm  pressure,  as  though  trying  to  force 
the  bristles  between  the  teeth,  using  a  slight  rotary 
or  scrubbing  motion,  thus : 

This  movement    will  be    found    to 


of  the  above  methods  of  brushing,  and 


method  will  be  surprised  at  the  results 

obtained.     Care  should  be  used  to  go       Fig.xxxiv  c. 

over  all  the  surfaces  of  the  teeth  in  this  manner. 

WATER  CLEANSING  IS  MOST  IMPORTANT.— 
When  the  brushing  is  finished,  the  user  should  take  in 
the  mouth  luke-warm  water,  and  with  the  use  of  the 
lips,  cheek  and  tongue,  using  all  the  force  that  the  indi- 
vidual can  bring  to  bear,  force  the  water  in  between 
and  around  the  teeth,  repeating  this  cleansing  process 
several  times.  This  is  as  important  a  part  of  the  correct 
tooth  toilet  as  is  the  use  of  tooth  brush  and  tooth  paste. 
After  a  short  time  the  power  to  force  the  water  be- 
tween and  around  the  teeth  will  be  increased  until  one 
who  uses  this  method  will  be  astonished  at  how  much 
debris  can  be  washed  out  this  way,  after  a  careful 
use  of  the  dental  cream  and  the  brush." 

*  By  Courtesy  of  The  National  Mouth  Hygiene  Association. 

—121— 


EXTRACTING  TEETH  AND  ORAL  SURGERY. 

CHAPTER  IX. 

In  this  day  and  age  of  the  world  it  should  be  unnec- 
essary to  extract  teeth.  Unfortunately  there  are  a 
great  many  lost  because  many  people  neglect  their 
teeth  until  extraction  is  the  only  remedy.  In  children 
the  temporary  teeth  are  often  lost  before  it  is  time  for 
these  little  teeth  to  be  shed.  Through  neglect  the  teeth 
of  the  little  ones  often  are  allowed  to  decay,  and  "gum- 
boils" are  formed,  which  make  extraction  necessary. 
THESE  LITTLE  TEETH  SHOULD  BE  RETAINED 
UNTIL  TIME  FOR  THEM  TO  BE  REPLACED  BY 
THE  PERMANENT  TEETH,  IN  ORDER  THAT 
THE  BONES  OF  THE  FACE  AND  JAW  MAY  DE- 
VELOP PROPERLY. 

However,  cases  happen  where  these  temporary  teeth 
are  retained  over  the  normal  time,  and  the  permanent 
teeth  begin  to  come  in  under  or  beside  them.  In  such 
cases  these  teeth  should  be  removed,  in  order  to  allow 
the  permanent  teeth  to  erupt  evenly. 

Should  it  be  necessary  to  extract  teeth  for  these  little 
ones  it  can  be  done  painlessly,  PROVIDED  THE 
CHILD  HAS  NOT  BEEN  FRIGHTENED  BEFORE- 
HAND, by  parents  or  others  telling  the  child  he  will  be 
hurt    when    the    tooth    is    ''pulled".    Never  frighten 

—122— 


EXTRACTING  TEETH  AND  ORAL  SURGERY 


children  or  punish  them  by  telling  them  buga- 
boo stories,  or  theaten  them  with  having  their 
teeth  **pulled".  The  punishment  will  return  ten 
fold  to  the  one  who  gave  it,  the  first  time 
that  person  takes  one  of  these  ''frightened  kids" 
to  the  dental  office,  or  perhaps  has  to  sit  up  all 
night  with  one  who  has  the  toothache,  and  is  afraid  to 
have  anj^hing  done  to  the  tooth. 

Often  children,  in  playing,  may  fall  or  run  against 
something,  and  knock  a  tooth  loose.  These  teeth 
should  not  be  extracted.  A  speedy  trip  to  the  dentist 
may  save  the  tooth.  The  loosened  tooth  can  be  anchored 
solid,  and  will  usually  grow  back  firm. 

If  let  go  without  treatment  the  tooth  may  be  lost. 
Teeth  knocked  entirely  out  of  the  socket  can  sometimes 
be  replaced,  and  will  grow  firm  again  if  properly  fast- 
ened until  healing  takes  place.     The  tooth  should  be 

kept  from  getting 
dirty  if  possible, 
especially  dirt 
from  the  ground. 
After  adult  life 
is  reached  it  should 
not  be  necessary 
to  have  teeth  ex- 
tracted; but  older 
people  neglect 
their  teeth  as  well 

Figure  XXXV.    Irreaiilar  teeth  caused  bv 

extraction   of  one  tooth.  '    aS     yOUUgCr     OnCS, 

and  often  have  to 
—123— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

have  them  removed.  Sometimes  a  patient  comes  in  with 
the  toothache  and  insists  that  the  tooth  be  extracted. 
On  examining  the  tooth,  the  dentist  finds  that  it  can 
be  treated,  saved,  and  made  useful.  Usually  the 
patient  will  be  willing  to  have  this  done.  Occasionally 
a  patient  will  insist  on  having  the  tooth  removed,  say- 
ing one  less  will  not  make  any  difference.  It  does 
make  a  difference,  and  the  dentist  is  justified  if  he  re- 
fuses to  extract  a  good  tooth.  One  tooth  out  may  dis- 
arrange the  entire  masticating  apparatus  on  that  side. 
When  one  tooth  is  extracted  from  a  full  set  it  means 
damage  to  five  other  teeth  adjacent  to  it.     (Fig.  35). 

Abscessed  teeth,  as  a  rule,  should  be  extracted,  un- 
less they  can  be  readily  cured.  Teeth  that  have  once 
been  treated  and  afterward  abscess  are  difficult  to 
save.  They  are  usually  chronic  cases,  and  the'  al- 
veolar process  is  diseased  to  some  extent,  and  the 
teeth  loosened.  Where  teeth  are  crowded  it  may  be 
necessary  to  extract  one  or  more,  but  usually  they  can 
be  straightened  by  the  orthodontist  without  extract- 
ing any  of  them. 

Teeth  which  are  badly  neglected  and  are  covered  by 
deposits,  often  have  to  be  removed,  because  of  their 
loosened  condition  and  the  diseased  gums.  This  condi- 
tion is  called  pyorrhea,  and  pus  will  be  found  around  the 
teeth.  Such  teeth  should  be  removed  at  once,  if  it  is 
not  possible  to  quickly  cure  them.  Pus  around  the  teeth 
will,  if  left,  cause  more  serious  affections  in  the  throat, 
ears,  eyes,  or  more  distant  parts  of  the  body.  After  the 
teeth  are  removed,  flow  of  pus  stops  and  the  gums  heal. 

—124— 


EXTRACTING  TEETH  AND  ORAL  SURGERY 

Teeth  can  usually  be  extracted  without  pain,  if  there 
are  no  unusual  diseased  conditions  to  prevent  the  ab- 
sorption of  the  anesthetic  into  the  gum.  The  bad  re- 
pute that  extracting  of  teeth  bears,  is  due  to  th6  fact 
that  formerly  nothing  was  used  to  anesthetize  or 
deaden  the  gums.  Teeth  were  taken  out  with- 
out an  effort  being  made  to  relieve  the  pain, 
and  the  experiences  some  of  these  people  had, 
especially  those  who  would  have  fifteen  or  twenty 
teeth  removed  at  one  time,  are  told  even  to- 
day. By  the  use  of  local  anesthetics  the  gum  may  be 
deadened,  and  a  tooth,  or  several  teeth,  removed,  and 
not  the  least  bit  of  pain  be  experienced. 

Some  people  have  an  idea  that  where  a  tooth  is  ab- 
scessed, it  should  not  be  extracted  until  the  abscess 
gets  well.  This  is  a  mistaken  idea,  for  the  abscess  will 
not  heal  of  its  own  accord.  It  may  break  and  let  some 
of  the  pus  out,  and  become  less  painful,  but  it  is  not 
well.  If  one  has  a  splinter  in  the  flesh,  and  it  is  fester- 
ing, it  would  be  very  foolish  to  leave  the  splinter  in, 
expecting  the  festered  place  to  get  well.  The  physi- 
cian would  pull  the  splinter  out,  and  clean  the  wound 
so  that  it  could  heal  quickly. 

And  this  is  what  should  be  done  with  the  abscessed 
tooth.  Formerly  it  was  thought  to  be  dangerous  to 
extract  an  abscessed  tooth,  but  there  is  no  more  danger 
than  in  extracting  any  other  tooth,  and  by  an  early 
extraction  much  needless  suffering  may  be  avoided. 
Sometimes  teeth  that  are  diseased  are  neglected  until 
they  are  very  difficult  to  extract,  or  other  diseased  con- 

—125— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

ditions  may  be  present.  The  patient  delays  until  the 
suffering  can  be  borne  no  longer.  Then  he  goes  to  the 
dentist  and  has  the  diseased  tooth  extracted. 

This  'does  not  always  cure  the  abscess,  because  in- 
fection may  enter  the  wound  from  other  infected 
teeth,  or  the  patient  may  carry  infection  to  the  wound 
with  the  finger.  Keep  the  fingers  away  from  the  mouth, 
after  having  a  tooth  extracted.  The  hands  easily  carry 
infection  from  things  they  come  in  contact  with,  and 
the  patient  himself  may  infect  the  wound  and  after- 
^svard  may  want  to  blame  the  dentist.  Sometimes  the 
tissues  continue  to  swell  and  hurt;  or  the 
patient  may  perhaps  be  getting  along  all  right, 
and  disobeys  instructions,  by  going  to  work  or 
to  places  of  amusement  sooner  than  he  should  and  ag- 
gravates his  condition.  Then  when  his  sufferings 
continue  he  wants  to  abuse  the  dentist,  and  blame 
him  for  his  condition.  Sometimes  legal  proceedings 
are  brought  against  a  dentist  in  such  cases,  but  they 
are  seldom  successful.  Sometimes  an  unprincipled 
rival  dentist  may  encourage  a  patient  to  sue  his  dentist, 
to  get  revenge  for  some  fancied  wrong;  but  when  he 
gets  on  the  witness  stand,  this  other  dentist  has  to  tell 
the  truth  and  exonerate  the  man  he  has  tried  to  wrong. 

There  are  few  men  in  the  profession,  and  few  pa- 
tients, who  will  give  or  listen  to  such  unprincipled  ad- 
vice, for  every  one  recognizes  the  fact  that  no  profes- 
sional man  would  jeopardize  his  reputation  by  inten- 
tionally injuring  a  patient,  or  be  careless  with  his 
treatment.      L.aiy  decayed  teeth  should  be  extracted 


EXTRACTING  TEETH  AND  ORAL  SURGERY 

early,  and  bad  results  will  seldom  follow,  and  the  den- 
tist  and  patient  will  both  be  better  oft*. 

LOCAL  ANESTHESIA.— Local  anesthesia  is  the 
local  injection  or  application  of  medicinal  agents,  in 
a  circumscribed  area,  to  render  that  part  insensible  to 
pain.  The  elimination  of  pain  from  surgical  opera- 
tions is  very  much  to  be  desired,  and  can  be  accom- 
plished with  a  local  anesthetic  in  minor  operations^ 
and  thus  avoid  a  general  anesthetic.  Cocaine  was 
formerly  much  employed  as  an  anesthetic  agent, 
but  there  are  drugs  much  safer  than  cocaine,  and 
these  are  used  almost  exclusively  now  in  preference 
to  cocaine. 

Among  the  latter  drugs  is  novocaine.  It  is  one  of  the 
safest,  if  not  the  safest,  drug  that  can  be  used  as  a  local 
anesthetic.  Applied  locally  it  has  no  after  effects,, 
and  is  not  irritating  to  the  soft  tissues.  Secret  prepa- 
rations should  be  avoided,  and  any  one  who  adver- 
tises that  he  possesses  a  secret  drug  that  no  one  else 
can  get,  is  misrepresenting  things  to  his  patients. 

Dr.  Hermann  Prinz,  of  Philadelphia,  one  of  the 
best  authorities  on  drugs  in  the  United  States,  has 
made  a  very  complete  study  of  anesthetics,  and  has 
given  the  result  of  his  studies  to  the  professions,  and 
any  legally  qualified  person  may  avail  himself  of  this 
knowledge  and  the  use  of  these  drugs. 

Dentistry  is  a  branch  of  the  medical  profession,  and 
physicians,  from  time  immemorial,  have  given  freely 
of  their  knowledge  to  their  medical  brethren,  in  order 
to  relieve  the  sufferings  of  humanity.    To  do  otherwise 

—127— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

is  to  practice  the  methods  of  the  charletan  or  quack. 

Another  local  anesthetic  sometimes  used  is  the 
Ethyl  Chloride  Spray.  For  the  extraction  of  teeth,  or 
opening  of  abscesses,  the  spray  is  directed  against  the 
gums  until  they  are  covered  with  ice  crystals  and  have 
turned  white.  This  is  often  referred  to  by  patients 
as  ''freezing"  the  gums. 

GENERAL  ANESTHETICS.— General  anesthetics 
are  drugs  which,  when  inhaled  into  the  lungs, 
act  on  the  central  nervous  system,  and  cause  the  pa- 
tient to  be  insensible  to  pain  or  any  other  sensation. 
The  principal  general  anesthetic,  and  the  safest  one 
used  in  dental  operations,  is  a  combination  of  nitrous 
oxide  and  oxygen.  It  is  sometimes  called  ''laughing 
gas."  This  is  due  to  the  fact  that  nitrous 
oxide  produces  exhilarating  effects  on  some  pa- 
tients, causing  them  to  laugh  or  cry,  or  have 
"funny  dreams."  These  effects  are  mostly  due 
to  the  use  of  the  gas  in  a  pure  form.  When 
used  with  oxygen  these  exhilarating  effects  are  nut 
noticeable. 

Formerly,  when  nitrous  oxide  alone  was  used,  the 
period  of  anesthesia  was  very  short,  but  prolonged  an- 
esthesia, by  means  of  a  mixture  of  nitrous  oxide  and 
oxygen,  is  now  possible,  and  is  used  in  hospitals  for 
some  of  the  larger  operations. 

A  patient  may  be  kept  under  the  influence  of  this  an- 
■esthetic  long  enough  to  remove  one  tooth,  or  to  open 
a  painful  abscess,  and  no  knowledge  or  sensation  of 
pain  will  be  experienced  by  the  patient.    Within  a  few 

—128— 


■EXTRACTING    TEETH    AND    ORAL    SURGERY 

aninutes  after  the  anesthetic  is  discontinued  the  pa- 
tient returns  to  a  normal  condition,  and  will  be  able 
to  get  up  from  the  chair  and  return  home,  or  go  about 
Ihis  business,  without  feeling  any  ill  effects. 

The  only  people  who  will  have  any  difficulty  taking 
nitrous  oxide  are  those  who  have  recently  indulged  in 
a  full  meal  or  intoxicating  liquor.  No  one  should  take 
^  general  anesthetic  on  a  full  stomach,  because  it  will 
cause  nausea. 

Nitrous  oxide  with  oxygen  is  the  safest  general  an- 
esthetic, and  is  not  unpleasant  to  take.  Many  thou- 
sands of  administrations  of  this  anesthetic  have  been 
recorded  and  death  has  never  resulted  from  its  use. 
Some  few  deaths  have  been  charged  to  nitrous  oxide  in 
former  years  where  the  gas  has  been  used  alone.  But 
.  impartial  investigations  have  shown  that  these 
deaths  were  not  due  to  nitrous  oxide,  but  from  fright 
affecting  a  diseased  heart.  The  few  deaths  recorded 
would  have  happened  with  any  anesthetic,  or  even 
v^ithout  any.  But  where  oxygen  is  given  with  the  ni- 
trous oxide,  there  is  no  more  danger  than  with  a  local 
anesthetic. 

Neither  chloroform  or  ether  should  be  used  for  an 
anesthetic  in  minor  dental  operations,  except  by  the 
advice  and  aid  of  the  family  physician. 

SURCxERY  OF  THE  MOUTH  AND  JAWS.— Many 
people  still  think  only  of  the  dentist  as  one  who  is  able 
to  relieve  an  aching  tooth,  or  extract  or  fill  teeth,  and 
make  artificial  substitutes  to  replace  the  teeth  that  are 
lost.     This  may  have  been  a  good  conception   of  den- 

—129— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

tistry  in  the  past,  but  is  not  of  the  dentistry  of  to-day. 
Dentistry  has  rapidly  advanced  along  with  the  rest  of 
the  world,  and  has  attained  a  high  place  as  a  healing  art^ 
retaining,  but  improving  the  mere  mechanical  part  of 
dentistry,  and  has  become  skilled  in  the  therapeutical 
and  surgical  department  of  the  profession.  This  has 
resulted  in  many  of  the  diseases  and  accidents,  for- 
merly treated  by  surgeons  and  physicians,  being  re- 
ferred to  the  dentist  or  oral  surgeon,  who  makes  a 
specialty  of  treating  these  diseases  and  accidents  to  the 
face  and  mouth.  This  is  so  well  recognized  that  prac- 
titioners in  medicine  and  surgery  refer  such  cases  to 
the  dentist,  or  call  him  in  to  co-operate  in  the  treat- 
ment of  oral  diseases,  and  especially  in  fractures  of  the 
jaw.  The  war  in  Europe  has  given  the  dentists  of  the 
world  an  opportunity  to  prove  their  worth  as  members 
of  the  healing  art.  Here  most  of  the  wounds  re- 
ceived are  of  the  head  and  face,  and  many  of  these  are 
disfiguring,  making  the  person  repulsive  to  look  upon. 
Dental  surgeons  have  done  much  to  relieve  these  suf- 
ferers, and  by  mechanical  means,  to  replace  lost  teeth 
and  bones  of  the  face :  and  by  plastic  operations,  to  re- 
shape the  disfigured  features  back  into  a  semblance  of 
human  form. 

FRACTURES  OF  THE  JAW.— The  lower  jaw,  be- 
cause of  its  prominence,  is  often  injured  or  frac- 
tured, because  it  is  more  frequently  exposed  to  vio- 
lence than  other  parts  of  the  face.  The  lower  jaw  is 
a  piece  of  bone,  bent  at  the  chin,  and  at  the  angles  of 
the  jaw,  and  loosely  attached  to  the  base  of  the  skulL 

—130— 


EXTRACTING  TEETH  AND  ORAL  SURGERY 

by  ligaments.  The  tooth  sockets  make  it  rather  frail 
in  the  most  important  part,  and  easily  broken.  When 
the  jaw  is  fractured,  the  displacement  of  the  parts  is 
made  worse  by  the  action  of  the  muscles  which  are  at- 
tached to  the  jaw.  Fractures  of  the  lower  jaw  are 
usually  between  the  cuspid  and  first  bicuspid,  the  jaw 
being  weakest  here  because  of  the  long  root  of  the  cus- 
pid, or  "stomach  tooth."  Such  fractures  may 
be  on  one  or  both  sides  of  the  jaw,  although 
fractures  occur  at  other  parts  of  the  jaw.  The  lower 
jaw  is  the  most  prominent  of  the  bones  of  the  face, 
and  if  not  properly  set,  the  deformity  resulting  is 
more  noticeable  than  that  of  any  other  part,  unless  it 
is  that  of  the  nose. 

TREATMENT.— Treatment  consists  of  caring  for 
the  tissues  of  the  mouth  and  keeping  them  in  clean 
condition,  placing  the  broken  parts  together,  and  in 
the  attachment  of  a  suitable  appliance  to  retain  them 
in  position  until  healing  takes  place,  so  that  no  de- 
formity may  result.  This  retention  may  be  done  by 
means  of  wires  to  tie  and  hold  the  bones  in  position,  or 
by  the  use  of  sutures  which  are  absorbable,  by  metal 
plates,  or  by  dental  splints.  The  dental  profession  has 
devised  many  of  the  appliances  which  enable  fractures 
of  the  jaw  to  be  treated  successfully.  As  soon  as  the 
jaw  is  fractured,  treatment  should  be  begun,  as  soon 
as  professional  help  can  be  procured,  for  the  earlier  the 
parts  are  put  together  the  lesser  the  chance  for  in- 
fection of  the  mouth  tissues,  or  deformity  of  the  jaw. 

In  the  European  War,  the  method  of  trench  war- 

--131— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

fare  exposes  mostly  the  head  and  upper  part  of  the' 
body,  and  wounds  of  the  head  and  face  are  more  usual 
than  of  other  parts  of  the  body.  Here  the  general 
surgeon  and  the  dental  surgeon  work  together.  Some 
years  ago  contract  dental  surgeons  were  appoint- 
ed to  serve  with  the  United  States  Army,  and 
care  for  the  soldiers'  teeth,  for  it  was  recognized  that 
the  soldier  must  have  a  good  masticating  apparatus  in 
order  to  keep  in  good  fighting  trim.  Recently  Con- 
gress has  enacted  new  army  dental  legislation,  doing 
away  with  the  old  contract  system,  and  granting  a 
commissioned  standing  to  these  dentists,  with  a  cer- 
tain amount  of  promotion  provided  for.  The  number 
of  dentists  in  the  Army  has  also  been  increased  in 
proportion  to  the  increase  in  the  Army. 

The  American  dentist  has  always  stood  at  the  head 
of  his  profession  throughout  the  world,  and  the  new 
army  dental  bill  provisions  will  draw  the  best  of  the 
young  dentists  of  the  country  into  the  dental  corps, 
and  provide  a  good  dental  service  for  our  Army. 

The  United  States  Government  also  provides  for 
dental  service  to  the  men  in  the  navy.  This  is  anoth- 
er means  of  raising  the  efficiency  of  the  navy  to  the 
highest  standard  in  the  world,  by  improving  the  health 
and  physical  comfort  of  the  men.  Thus  our  govern- 
ment recognizes  that  good  teeth  are  requisite  for  the 
making  of  a  good  soldier  or  sailor. 


—132- 


ARTIFICIAL  TEETH. 

CHAPTER  X. 

When  the  natural  teeth  are  lost,  they  should  be  re- 
placed by  substitutes,  to  restore  the  jaws  to  their 
proper  position,  preserve  the  natural  facial  appear- 
ance, and  restore  speech  and  mastication.  For  the 
teeth  are  not  only  necessary  to  mastication  and  good 
appearance,  but  also  to  speech. 

When  any  of  the  teeth  are  missing,  speech  is  more 
or  less  interfered  with,  and  if  all  the  teeth  are  gone 
it  is  impossible  to  articulate  many  words  properly, 
and  speech  becomes  badly  impeded  and  distorted. 
Speakers  and  singers  realize  this  more  than  any  oth- 
er class  of  people.  The  food  must  be  properly  masticat- 
ed if  it  is  to  be  digested  properly,  and  if  the  teeth  are 
out,  this  becomes  impossible,  and  the  general  health 
suffers. 

The  gastric  juice  cannot  act  properly  on  unchewed 
food,  and  the  body,  as  a  result,  cannot  receive  all  the 
nourishment  which  is  in  the  food.  Elderly  people 
need  all  the  nourishment  they  can  obtain  from  their 
food,  and  these  people  usually  are  the  ones  who  are 
without  their  natural  teeth,  although  younger  people 
are  sometimes  unfortunate  enough  to  have  all  their 
teeth  extracted,   and    to    have    plates    made.     Good 

—133— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

liealth  requires  good  digestion  and  assimilation  of  the 
food  taken  into  the  body.  This  is  not  possible  without 
a  good  masticating  apparatus. 

Modern  dentistry  is  able  to  replace  the  natural  teeth 
with  artificial  dentures,  so  good  that  the  natural  ap- 
pearance is  restored  to  the  features,  and  speech  and 
mastication  are  made  normal.  Artificial  plates  are 
made  to  replace  a  few  teeth  that  are  missing,  as,  for 
instance,  the  four  or  six  upper  front  teeth,  oj  to  re- 
place the  entire  set  of  teeth  in  either  one  or  both 
jaws.  Plates  are  usually  made  of  two  parts — the 
teeth;  which  ara  made  of  porcelain,  and  the  plate, 
which  may  be  mads  of  rubber  or  metal,  to  conform  to 

the  shape  of 
the.  gums 
and  hard 
palate,  and 
retain  the 
ientures  in 
place.  Rub- 
b  e  r     Tilate*^^ 

Figure  XXXVI.   An   artificial  upper  denture.       ^  ^  ^    more 

usually  employed,  because  they  are  less  expensive, 
and  rubber  makes  a  serviceable  plate,  which,  with 
proper  care,  will  last  for  years. 

Partial  dentures  are  often  made  to  replace  a  few 
teeth  that  are  missing,  especially  the  four  or  six  up- 
per front  teeth,  and  give  good  service,  and  restore  the 
appearance  anti  the  masticating  surface.  However, 
if  the  remainder  of  the  teeth  are  sound,  and  the  gums 

—134— 


ARTIFICIAL  TEETH 

healthy,  it  may  be  better  to  use  bridge  work  to  re- 
place these  teeth. 

A  partial  plate  is  apt  to  wear  against  the  necks 
of  the  remaining  teeth,  and  cause  abrasion,  and  the 
gums  will  sometimes  recede  away  from  the  teeth. 
This  does  not  happen  where  bridge  work  is  used.  Be- 
sides the  palate  will  not  be  covered  over  where  bridge 
work  is  used.  In  the  use  of  any  plate  in  the  upper 
jaw,  the  palate  is  covered  by  the  plate,  and  food  is 
not  tasted  so  well  as  when  the  tongue  is  allowed  ta 
come  in  contact  with  the  rugae  of  the  palate. 

A  full  upper  denture  is  usually  easier  to  fit  than  a 
partial  denture.  There  are  no  teeth  to  trim  around 
to  make  a  fit,  and  the  form  of  the  upper  gum  ridge 
makes  the  task  easier,  because  there  are  definite  lines, 
to  be  followed  in  trimming  down  the  plate. 

The  rugae  should  be  reproduced  in  the  part  of  the^ 

plate  that 
comes  next 
to  the 
tongue  and 
aids  in  tast- 
i  n  g  the 
food. 

Figure  XXXVII.    An   Artificial  Lower  Denture.  The   loWCF 

teeth  are  som.etimes  more  difficult  to  replace,  because 
the  lower  gum  ridge  is  only  a  narrow  band  of  tissue, 
and  in  some  cases  has  been  allowed  to  shrink  away 
until  there  is  very  little  tissue  left  to  support  the 
plate  in  position. 

—135— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

Usually,  however,  a  lower  plate  can  be  made  to  stay 
in,  and  if  the  gum  has  not  shrunken  too  much  there 
will  be  no  trouble.  Most  plate  failures  are  caused  by 
the  patient  waiting  too  long  before  having  the  plate 
made.  Many  people  will  *'hang  on"  to  a  few  old  diseased 
snags  or  teeth,  with  pus  around  the  roots,  and  wait 
until  the  teeth  cannot  be  retained  any  longer.  By  this 
time  the  articulation  has  been  disarranged  and  they 
have  developed  an  abnormal  bite.  They  cannot  place 
the  jaws  together,  in  the  same  position,  two  times  in 
succession.  Then  some  others  will  have  all  the  teeth 
removed,  and  wait  six  months  or  a  year  before  they 
have  their  plates  made.  By  this  time  the  jaw,  having 
nothing  to  support  it,  has  become  a  little  unhinged 
from  its  attachment  to  the  upper  jaw,  and  drops  down 
and  a  little  forward.  This  causes  the  lower  ridge  to 
advance  in  a  line  ahead  of  the  ridge  in  the  upper  jaw, 
and  throws  the  bite  out  of  line. 

This  can  be  avoided  if  the  impressions  are  taken 
soon  after  the  teeth  are  extracted,  and  temporary 
plates  made.  This  protects  the  tender  gums  from  in- 
jury, the  alveolar  process  does  not  absorb  so  quickly, 
and  there  is  not  so  much  gum  shrinkage.  This  gives 
more  holding  surface  to  retain  the  plate  when  the 
permanent  set  is  made,  six  months  or  a  year  later. 
Then  the  jaws  are  left  in  a  normal  position  by  the 
temporary  set  of  teeth,  and  the  *'bite"  or  articulation 
is  not  disarranged. 

The  pleasure  of  being  able  to  eat  and  enjoy  food 
during  these  months  of  waiting,  together  with  the 

—136— 


ARTIFICIAL  TEETH 


better  appearance  and  ability  to  speak  well,  will  more 
than  pay  for  any  little  discomfort  endured  in  get- 
ting used  to  a  temporary  set,  and  the  extra  expense  it 
may  cost.  The  same  porcelain  teeth  used  in  the  tempor- 
ary teeth  may  be  detached  and  used  in  the  permanent 
set  of  teeth.  It  is  usually  easier  to  make  a  complete  set 
of  teeth,  a  full  upper  and  lower,  than  a  partial  set,  or 
to  make  an  artificial  lower  to  fit  against  the  natural  up- 
per teeth,  or 
vice  versa. 

In  making  a 
complete  set 
of  upper  and 
lower  artifi- 
c  i  a  1  teeth, 
the  teeth 
come  match- 
ed, and  fit 
one  to  the 
other  set 
more  per- 
fectly. 
COLORS  OF  THE  TEETH.— Color  plays  a  great 
part  in  making  up  a  set  of  artificial  teeth,  and  colors 
or  shades  should  be  selected  that  will  harmonize  with 
the  physical  appearance  of  the  face,  in  order  that  the 
appearance  may  be  made  natural  and  harmonious 
with  the  general  complexion.  If  the  color  is  wrong, 
the  artificial  restoration  can  be  detected  at  once.     It" 

—137— 


Figure  XXXVIII.  Full  upper  and  lower  dentures. 
Gum  section  teeth  are  used,  and  reproduce  tlie 
appearance  of  tlie  natural  gum. 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

would  be  foolish  for  a  person  sixty  years  of  age  to  se- 
lect the  milk  white  color  of  teeth  like  the  child  of 
=eight  or  nine  years  old.  Middle  aged  people  and  even 
younger  people  complain  of  their  natural  teeth  not 
being  as  white  as  they  would  like  them.  Our  teeth 
wear  and  change  as  we  grow  older.  Gray  hair  and 
wrinkles  come  with  advancing  age.  Our  teeth  are 
subject  to  the  same  ageing  process,  and  if  the  color  of 
the  teeth  changes  from  the  milk  white  color  usual  in 
childhood  to  the  ''yellow  tooth"  of  old  age,  it  should 
be  accepted  as  the  mark  left  by  advancing  time. 

Neglect  and  abuse  may  discolor  the  natural  teeth 
prematurely,  but  each  decade  in  the  life  of  the  indi- 
vidual will  show  a  slight  change  in  the  teeth,  as  well 
as  of  the  general  appearance.  So  when  you  •  go  to 
your  dentist  for  your  ''new  teeth,"  let  him  select  the 
color  suitable  to  your  age  and  complexion  and  your 
general  appearance.  Your  dentist  has  made  a  study 
of  tooth  color,  and  will  select  a  color  more  suitable 
than  you  are  likely  to  do  for  yourself. 

If  you  should  be  unfortunate  enough  to  impose 
your  will  on  the  dentist,  and  select  a  tooth  color  suit- 
able to  the  sixteen  year  old  girl,  do  not  go  back  and 
blame  the  dentist  for  the  ghastly  appearance  of  your 
teeth.  Take  a  color  natural  to  your  age  and  appear- 
ance, and  the  result  will  be  more  harmonious. 

KINDS  OF  TEETH.— Teeth  come  in  various  molds 
or  shapes  to  suit  the  various  types  of  patients.  The 
form  and  shape  of  the  mouth,  as  well  as  the  facial 
appearance,  will  determine  the  shape  of  tooth  to  use. 

—138— 


ARTIFICIAL  TEETH 

The  up-to-date  dentist  often  uses  a  photograph  of  his 
patient  to  aid  him  in  the  selection  of  teeth  which  will 
harmonize  with  the  appearance  of  his  patient.  The 
distance  the  jaws  are  apart,  and  their  shape,  aid  the 
dentist  in  selecting  teeth  as  to  length,  size,  etc.  Teeth 
are  made  in  sets  of  fourteen  upper  and  fourteen  lower. 

The  natural  set  has  thirty-two  teeth,  but  in  a  full 
set  of  artificial  teeth  only  twenty-eight  are  used,  four- 
teen in  each  plate.  Some  of  the  teeth  are  made  sep- 
arate, fourteen  separate  teeth  to  the  set,  and  are  called 
plain  plate  teeth.  Others  are  made  in  sections  of  two 
or  three  teeth  to  the  section,  and  have  a  porcelain  gum 
at  the  top  to  reproduce  the  natural  appearance  of  the 
gums.  The  gum  part  of  the  section  is  colored  to  imi- 
tate the  natural  gums.  Others  are  made  in  sec- 
tions without  the  artificial  gum  baked  on.  All  these 
teeth  have  either  pins  attached  or  grooves  cut  in  the 
teeth,  to  secure  them  to  the  plate  which  holds  the 
denture  in  the  mouth. 

PLATE  MATERIALS.— Various  materials  are  used 
to  make  the  plates  on  which  the  teeth  are  set. .  Rubber, 
being  moderate  in  price  and  very  serviceable,  is  much 
used,  and  is  within  the  means  of  the  average  person. 
For  those  who  demand  the  best  service  and  materials,, 
some  of  the  precious  metals  are  used  as  a  base.  Gold, 
platinum  and  aluminum  are  the  ones  usually  used,  and 
give  the  best  results.  An  impression  is  taken  of  the 
mouth,  and  a  model  is  made,  usually  of  metal,  over 
which  the  gold  or  platinum  is  swaged  into  shape  to 
fit  the  mouth;     after  which  the  teeth  are  fastened  to 

—139— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

the  metal  plate.  Gold  or  aluminum  may  be  melted  and 
cast  to  the  form  of  the  plate  desired.  The  metal 
plate  is  light  in  weight,  and.  has  the  added  quality  of 
being  a  conductor  of  heat  and  cold.  Rubber  is  a  non- 
conductor of  heat  and  cold,  and  sometimes  the  tissues 
of  the  mouth  become  tender  or  swollen  from  contact 
with  the  rubber.  However,  few  people  are  troubled 
in  this  way.  The  physical  comfort  of  a  plate  made 
from  gold  or  platinum  is  so  much  more  pleasant  than 
that  of  rubber,  that  one  who  has  worn  both  kinds 
would  never  go  back  to  the  rubber  plate.  Platinum 
fuses  at  a  very  high  temperature,  and  on  this  account 
it  makes  a  very  desirable  base  for  a  denture.  The 
teeth  are  attached,  and  a  porcelain  gum  fused  direct- 
ly to  the  platinum  plate,  and  the  natural  appearance 
of  the  gums  restored.  There  are  no  joints  left  to  be- 
come filled  with  odors,  and  on  this  account  makes  the 
most  sanitary  denture,  as  well  as  a  beautiful  work  of 
restoration.  This  work,  however,  is  very  expensive, 
and  within  the  reach  of  few  people. 

CLEANING  ARTIFICIAL  TEETH.  —  Artificial 
teeth  should  be  cared  for  and  kept  clean  just  the  same 
as  the  natural  set  of  teeth.  Some  people  get  the  idea 
that  their  troubles  are  over  when  they  get  their  ''store 
teeth".  Such,  however,  is  not  the  case,  as  many 
have  learned  by  experience.  Few  things,  man-made, 
are  perfect,  and  artificial  teeth  lack  some  things  of 
being  perfect,  and  yet  if  carefully  made  they  are  ser- 
viceable and  comfortable,  and  a  boon  to  thousands 
who  would  be  doomed  to  a  ''toothless  old  age"  with- 

—140— 


ARTIFICIAL  TEETH 

out  them.  Any  mechanical  contrivance,  to  be  useful 
and  give  a  reasonable  amount  of  service,  must  have 
care.  An  artificial  denture  is  no  exception  to  this 
Tule. 

Artificial  dentures  are  constructed  upon  models  tak- 
en from  impressions  of  the  mouth,  and  they  are  made 
to  fit  gums  and  hard  palate  perfectly.  If  anything 
happens  to  distort  this  fit  the  plate  does  not  stay  in 
the  mouth  perfectly.  If  the  plate  fits  accurately  it 
sticks  firmly,  and  the  wearer  speaks,  eats,  and  goes 
about  his  work  without  any  difficulty. 

Take  two  pieces  of  glass,  as  an  example,  and  wet 
i:hem  with  water,  and  press  them  tightly  together.  It 
^11  be  found  that  one  adheres  firmly  to  the  other, 
and  they  are  pulled  apart  with  difficulty.  If  the  plate 
is  made  to  fit  accurately  it  adheres  to  the  gum  and 
palate  in  the  same  way.  The  wet  plate,  coming  in  con- 
tact with  the  moist  palate  and  gums,  and  being  pressed 
lip  close  until  all  the  air  is  expelled  from  between  the 
tissues  and  plate,  is  held  firmly  in  place.  AS  LONG 
AS  THE  PLATE  IS  CLEAN  IT  IS  EASILY  HELD 
IN  PLACE. 

Going  back  to  the  experiment  with  the  two  flat 
pieces  of  glass.  They  are  now  taken  apart,  and  a  few 
grains  of  sand  or  dirt  scattered  over  the  surface.  Now 
Iry  to  make  them  stick  together.  It  will  be  found  that 
they  do  not  stick  very  well.  So  it  is  with  the  artificial 
plate.  If  berry  seeds,  bread  crumbs,  and  other  food 
particles,  are  allowed  to  encumber  the  plate,  it  will 
not  fit  and  stick  to  the  mouth  as  well  as  if  clean. 

—141— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

The  plates  should  be  brushed,  and  all  stain  and  food 
removed  from  the  surface  of  the  teeth 
and  plate.  Regular  plate  brushes  are 
made  for  this  work,  and  it  is  easy  to 
keep  the  plates  clean  and  sweet  if  a 
little  care  is  given  them  each  day. 

After  each  meal  the  plates  should  be 
removed  from  the  mouth,  rinsed  and 
well  cleaned  with  water. 

Usually  all  that  is  needed  is  brush 
and  water.  A  powder  is  not  necessary. 
Sometimes  a  deposit,  similar  to  tartar  on 
the  natural  teeth,  will  collect  on  the  ar- 
tificial teeth.  This  should  be  scraped  off. 
If  the  plates  become  foul,  they  should  be 
taken  to  the  dentist,  and  have  the  de- 
posits removed  and  the  dentures  cleaned 
and  polished. 

Artificial  teeth  do  not  give  the  wearer 
a  foul  breath  unless  food  is  left  on  the 
plates  to  decay  and  become  foul,  and 
they  do  not  destroy  the  sense  of  taste. 
If  the  plate  is  ever  broken  it  can  usually 
be  quickly  repaired.  If  a  small  break  or 
crack  is  made  by  accidentally  dropping 
Figure  XXXIX.  the  plate,  which  sometimes  happens,  it 
A  plate  i)ru.sh.  gj^Q^j^  ^^  repaired  before  the  break  be- 

Artificial      den- 
tures should  be  comes    larger   and   perhaps    beyond    re- 
kept  clean.         pair.     Many    people    have    two    sets    of 

—142— 


ARTIFICIAL  TEETH 

teeth  made.  If  one  set  is  broken,  the  extra  set  is 
always  ready  for  use.  Busy  people  or  travelers  find 
this  extra  set  of  teeth  a  good  investment. 

In  conclusion,  remember  that  the  comfort  and 
usefulness  of  your  artificial  dentures  depend  much 
upon  keeping  them  clean.  It  is  just  as  reasonable  to 
expect  a  foul  plate  to  be  serviceable  and  comfortable, 
as  it  is  to  expect  a  pair  of  shoes  to  be  comfortable 
when  they  contain  a  few  grains  of  sand  to  tickle  the 
feet 


-143- 


DISEASES  OF  THE  MOUTH, 
AND  FIRST  AID  REMEDIES, 


CHAPTER  XL 

Bacteria  are  present  in  all  mouths ;  even  in  the- 
best  cared  for  mouths  conditions  are  favorable  for 
their  growth.  The  mouth,  being  a  warm,  moist  place,, 
is  a  natural  incubator.  If  bacteria  grow  in  cleart 
mouths,  they  will  surely  thrive  in  unclean  mouths, 
where  food  debris,  decay,  pus,  and  other  conditions 
are  so  favorable  for  their  development. 

Children  with  unclean  mouths  are  more  subject  to 
infections,  such  as  diphtheria,  scarlet  fever,  and  other 
diseases  incident  to  childhood. 

Children  with  clean  mouths  have  a  much  better 
chance  of  escaping  these  diseases  than  children  with 
unclean  mouths.  The  cleaner  the  mouth  the  less  i& 
the  danger  of  disease.  There  are  many  diseases  and 
conditions  that  affect  the  human  mouth,  but  in  a 
short  work  of  this  kind  all  of  them  cannot  be  men- 
tioned. Toothache  and  a  few  diseases  will  be  men- 
tioned, and  advice  given  on  some  home  remedies. 

TOOTHACHE. — This  is  one  of  the  common  sources 
of  pain,  as  many  of  us  have  found  from  experience. 
People  often  have  an  attack  of  toothache  when  it  is  not 
possible  to  visit  the  dentist,  and  resort  to  home  reme- 

—144— 


DISEASES  OF  THE  MOUTH,  AND  FIRST  AID  REMEDIES 

dies  is  the  only  chance  for  relief .  Often  ''carbolic  acid", 
liniments,  etc.,  are  resorted  to  for  relief.  These  reme- 
dies might  be  all  right  if  they  were  applied  in  the 
right  spot.  Unfortunately  they  are  not  usually  put 
where  they  will  do  the  most  good,  but  are  smeared 
aroun-d  the  tooth  and  on  the  gum,  and  as  a  conse- 
quence, when  the  patient  seeks  professional  aid,  the 
tissues  of  the  mouth  are  blistered  and  burned,  and 
the  mouth  is  so  inflamed  that  very  little  can  be  done 
for  permanent  relief  until  the  burns  heal. 

''Carbolic  acid"  and  liniments,  as  usually  applied  by 
the  home  remedy  friend,  are  about  as  effective  for  re- 
lieving toothache  as  grease  smeared  on  the  spokes  of 
a  squeaky  wheel.     When  the  teamster  or  the  automo- 
bilist  discovers  a  squeaky  wheel,  he  takes  it  off  and 
applies  the  grease  on  the  spindle  and  inside  the  hub, 
where  the  friction  is,  and  the  bearings  then  cease  their 
squeaking.     So  it    is  with  the  toothache,    the  remedy 
must  be  applied  at  the  seat  of  pain.    To  do  this,  locate 
the  decayed   cavity,    and  with   a  tooth-pick   or   small 
darning  needle,  pick  out  all    the    food    debris    which 
clogs  up  the  hole,  and  wash  the  cavity  out  with  warm 
water.      If  the  tooth  has  a  live  pulp,  the  ache  can  us- 
ually be  relieved  by  the  application  of  oil  of  cloves. 
Take  a  tooth-pick  or  small  piece  of  soft  wood  with  a 
small  pointed  end,  and  a  small  pledget  of  cotton  satur- 
ated with  the  oil,  and  apply  the  cotton  directly  into 
the  cavity  of  the  tooth,  using  the  wooden  pick  to  place 
the  cotton  in  position.     If  the  cavity  has  been  cleaned 
out  well,  so  food  does  not  press  against  the  live  nerve, 

—145— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

the  ache  should  be  relieved  within  a  few  minutes.  If 
oil  of  cloves  cannot  be  secured,  use  some  chloroform  or 
camphor,   and  apply  it  in  the  same  way. 

Over  this  pellet  of  cotton  containing  the  medicine, 
insert  another  dry  pellet  of  cotton,  to  help  confine  the 
medicine  in  the  cavity  and  protect  the  pulp  from  sud- 
den changes  of  temperature  or  pressure  from  food 
when  eating.  The  above  directions  are  for  aching 
teeth  with  live  pulps.  Phenol  (carbolic  acid)  is  some- 
times used ;  it  is  dangerous,  and  the  best  advice  is  not 
to  use  it.  If  an  acid  is  used  care  must  be  taken  to  ap- 
ply the  cotton  containing  it  in  such  a  way  that  none 
escapes  from  the  cavity  to  the  mouth.  If  it  does,  a 
burn  will  result.  Alcohol  or  whiskey  is  an  antidote 
for  "carbolic  acid"  burn,  and  if  the  mouth  is  burned, 
apply  the  alcohol  to  the  place  that  the  acid  touches. 
This  must  be  done  quickly,  for  acid  burns  quickly. 

To  find  out  whether  a  tooth  has  a  live  or  a  dead 
pulp,  take  some  very  cold  water  in  the  mouth,  and 
bring  it  into  contact  with  the  aching  tooth.  If  the 
pulp  is  alive,  the  pain  will  become  greater.  Apply 
warm  water  to  the  tooth  and  the  pain  will  quiet 
down.  Another  way  to  find  out  whether  the  pulp  is 
alive,  is  to  gently  press  a  tooth-pick  or  needle  against 
the  cavity.  If  the  pain  is  increased,  the  pulp  will  be 
found  to  be  alive.  In  teeth  with  live  pulps  any  sweet 
substance  in  the  cavity  will  cause  the  tooth  to  ache. 

TEETH  WITH  DEAD  PULPS.— Teeth  with  dead 
pulps  are  sore  to  the  touch,  and  feel  longer  than  the 
rest  of  the  teeth,  so  that  when  the  mouth  is  closed  the 

—146— 


DISEASES  OF  THE  MOITTH,  AND  FIRST  AID  REMEDIES 

sore  tooth  is  struck  first,  and  pain  results.  When  the 
pulp  dies  putrefaction  takes  place,  and  a  gas  is  formed, 
which,  confined  within  the  pulp  chamber  of  the  tooth, 
tries  to  find  some  way  of  escape.  This  it  usually 
does  from  the  end  of  the  root.  The  effect  of 
this  gas  pressing  upon  the  delicate  tissues  around 
the  tooth,  is  to  inflame  them,  and  they  get  sore,  swell 
up,  and  an  abscess  or  "gum-boil"  forms,  which  is  very 
painful  as  well  as  dangerous. 

Another  way  teeth  with  dead  pulps  may  be  dis- 
covered, is  by  their  discolored  appearance  and  foul 
odor.  The  treatment  for  these  teeth  is  to  clean  out  the 
cavity,  and  with  a  large  needle  or  a  small  sharp 
pointed  instrument,  puncture  a  hole  into  the  pulp 
chamber.  The  gas  will  then  escape  from  the  tooth 
and  relieve  the  pressure  within.  However,  these  cases 
progress  so  far  sometimes  that  the  effects  of  the  in- 
fection cannot  be  checked,  and  the  abscess  gets  worse. 
The  gum  around  the  tooth  swells  up  and  is  very  pain- 
ful. Within  a  few  days  pus  will  form,  and  the  ab- 
scess should  be  lanced,  or  the  ''gum.-boir'  may  break 
out  on  the  outside  of  the  gum,  and  the  pain  subsides. 
Sometimes,  when  these  abscesses  begin,  the  dentist 
can  check  them,  and  sometimes  he  will  not  be  able  to 
do  so.  A  hot  water  bottle  held  to  the  cheek  will  often 
give  temporary  relief,  or  the  water  may  be  ice  cold. 
Sometimes  alternating  between  hot  and  cold  applica- 
tions will  give  temporary  relief.  Care  must  be  taken 
when  these  abscesses  have  swollen  out  the  cheek,  in 
applying  heat  to  the  outside  of  the  face,  because  the 

—147— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

abscess  may  be  drawn    out  and  break    outside,    and 
leave  an  ugly  scar. 

If  unable  to  reach  a  dentist  at  once,  apply  a  mixture 
of  iodine,  or  better  still,  of  aconite  and  iodine,  over 
the  gums.  Pull  back  the  lip  and  dry  the  gum  with  a 
piece  of  cotton,  and  then  apply  the  remedy  with  a 
small  camel's  hair  brush,  or  a  piece  of  cotton  wound 
on  the  end  of  a  tooth-pick  or  stick.  Allow  the  aconite 
and  iodine  to  dry  before  releasing  the  lip.  Treating 
an  abscess  at  home  is  one  of  the  most  unsatisfactory 
home  treatments.  The  abscess  should  receive  treat- 
ment at  the  hands  of  one  who  has  the  proper  instru- 
ments to  reach  the  seat  of  trouble,  which  is  usually 
far  up  in  the  gum  out  of  reach  of  ordinary  remedies. 
Sometimes  people  endure  these  abscesses  until  they 
swell,  and  the  pus  breaks  out  of  its  own  accord,  and 
the  patient  thinks  it  is  all  right.  Right  here  is 
where  the  dangerous  stage  is  reached.  The  abscess 
is  easy,  but  there  is  a  constant  discharge  of  pus,  car- 
rying infection  to  the  throat.  The  food  is  mixed  with 
the  pus,  and  carries  infection  to  the  stomach  and 
bowels,  and  often  to  the  appendix.  Many  cases  of  ap- 
pendicitis, or  cases  of  eye  or  ear  trouble,  or  of  rheuma- 
tism, may  be  traced  to  abscesses  in  the  mouth. 

Delay  in  treating  these  conditions  is  dangerous.  The 
sooner  they  are  attended  to  the  better  it  is  for  the  health 
of  the  individual.  Where  the  tooth  has  formerly  been 
treated  and  the  root  canal  filled,  and  an  abscess  forms, 
it  is  difficult  to  cure.  Usually  it  is  necessary  to  extract 
such  a  tooth,  but  an  effort  should  be  made  to  save  it. 

—148— 


DISEASES  OF  THE  MOUTH,  AND  FIRST  AID  REMEDIES 

CANKER  SORES.— This  affection  is  a  common  one, 
and  is  usually  referred  to  as  canker  sore  mouth. 
Children  with  catarrhal  stomatitis  frequently  have 
little  sores  in  the  mouth  during  or  after  dentition. 
The  most  common  is  the  single  sore  in  the  mouth  of 
the  adult.  These  sores  usually  come  where  two  mu- 
cous membranes  meet,  as  the  gums  with  the  lips  or 
cheek,  or  the  tongue  or  the  gum  with  the  floor  of  the 
mouth.  The  local  pain  is  annoying.  There  is  a  little 
swelling  and  redness  around  the  sore  spot,  which  is 
somewhat  hardened. 

This  place  breaks  down,  and  a  raw  surface  is  formed 
with  a  yellowish  white  coating.  These  sores  are  then 
very  painful.  In  children  these  ulcerations  are  treat- 
ed by  giving  a  laxative.  As  a  mouth  wash,  a  solution 
of  potassium  chlorate  may  be  used.  In  treating  canker 
sore  in  adults,  calomel  should  be  given  at  night,  fol- 
lowed in  the  morning  by  a  saline  laxative.  If  one  does 
not  like  calomel,  some  other  cathartic  may  be  substi- 
tuted for  the  calomel. 

The  local  sore  should  be  dried  and  pure  ''carbolic 
acid"  applied  to  the  sore  and  the  reddened  area  just 
around  it.  After  a  moment  the  acid  will  have  cauterized 
the  sore,  and  pure  alcohol  should  be  applied,  the  dead 
flesh  cleaned  away,  and  a  little  iodine  applied.  Healing 
should  take  place  within  a  few  days,  and  the  pain 
should  be  relieved  within  a  few  minutes  after  cauter- 
izing. The  administration  of  milk  of  magnesia  will 
often  help  the  gastric  conditions  unless  of  long  stand- 
ing.    The  eating  habits  should  be  regulated,  care  be- 

—149— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

ing  taken  not  to  eat  foods  which  cause  digestive  dis- 
turbances. 

NEURALGIA. — Pain  referred  to  some  other  part  of 
the  body  other  than  its  origin  is  characteristic  of  dis- 
eases of  the  pulp.  This  is  more  true  of  chronic  diseases 
of  the  teeth  than  those  that  are  acute  or  just  beginning. 

In  people  subject  to  neuralgia,  any  chronic  disease 
of  the  teeth  may  cause  pain  in  other  parts  of  the  body 
or  head.  Due  to  some  systemic  condition,  pulp  nodules 
may  form  in  teeth  that  are  apparently  sound,  and 
cause  reflex  pains  in  some  other  part  of  the  body. 
There  may  be  no  definite  location  of  pain  in  these 
cases,  but  tenderness  of  the  eye  when  pressed  against, 
pain  in  the  temple,  or  ears,  or  other  parts  of  the  head, 
and  pain  even  as  far  as  the  shoulder.  # 

When  teeth  have  decay,  all  cavities  should  be  filled, 
teeth  treated  where  needed,  and  all  diseased  roots  ex- 
tracted. Where  root  canals  are  filled,  they  should  be 
X-Rayed  to  find  out  if  the  canals  are  properly  filled. 
Many  of  these  cases  of  neuralgia  are  treated  by  the 
family  physician  for  temporary  relief  from  pain,  but 
the  patient  should  have  the  source  of  trouble  corrected. 
Often  the  X-Ray  will  reveal  conditions  in  obscure  cases 
of  neuralgia,  which,  if  taken  as  soon  as  neuralgia 
begins,  will  enable  the  physician  or  dentist  to  locate  tne 
cause  and  apply  a  remedy. 

Crowded  teeth  sometimes  cause  neuralgia  pains. 
The  lower  third  molars  are  the  teeth  which  more  often 
cause  trouble,  because  of  the  close  relation  of  theii: 
roots  to  the  inferior  dental  nerve. 

—150— 


DISEASES  OF  THE  MOUTH,  AND  FIRST  AID  REMEDIES 

Third  molars  are  often  impacted,  that  is,  the  crowns 
grow  forward  toward  the  back  part  of  the  tooth  just 
in  front,  preventing    full  eruption,    which    jams    the 


The  Cranial  Nerves. 

5^>  Nervc-Trigeminus 


iotter.del 


Figure  XL.      Showing"  connection  of  nerves  of  teeth 
to    other   nerves   of   head    and    face. 
Permission  of  P.  Blakiston's  Son  &  Co.,  Philadelphia. 

tooth,   between   the  tissues   and   the   tooth   in   front, 

—151— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

causing  a  painful  condition,  and  sometimes  a  swelling 
or  abscess  and  a  ''stiff  jaw." 

In  impacted  third  molars,  or  those  whose  eruption 
is  slow  or  delayed,  the  crowded  condition  may  cause 
reflected  pain  to  any  organ  of  the  head,  because  the 
nerves  which  supply  the  ear,  eyes,  teeth  and  face,  are 
mter-related  to  each  other,  and  pain  in  one  set  of 
nerves  may  be  reflected  to  another  set,  and  cause  pain 
some  distance  from  the  source  of  trouble.  Disease  in 
some  other  part  of  the  body  may  cause  neuralgia  pains 
in  sound  teeth  or  the  tissues  surrounding  the  teeth. 
Chronic  malaria,  syphilis,  diseases  of  the  ear,  or  dis- 
orders of  the  lower  bowels,  causing  constipation,  may 
cause  neuralgia  pains  in  the  teeth. 

Another  cause  of  pain  in  the  teeth  is  pregnancy, 
and  is  very  common  even  when  no  trace  of  dental 
disease  can  be  found. 

HARELIP  AND  CLEFT  PALATE.— Cleft  palate 
may  be  either  congenital  or  acquired.  When  a  child 
is  born  with  a  cleft  in  the  palate,  there  is  usually  also  a 
cleft  lip  which  is  called  harelip.  Thanks  to  surgery, 
most,  if  not  all  these  early  clefts  may  be  closed  by  an 
operation.  This  can  be  done  the  first  twenty-four 
hours  after  birth,  and  if  done  at  this  time  the  defect 
is  soon  healed,  and  the  functional  results  are  better. 
The  infant  is  able  to  take  nourishment  better,  and 
much  heartache  and  embarrassment  saved  the  par- 
ents by  early  operation  and  cure.  If  left  until  a  later 
age,  or  until  the  child  learns  to  speak,  the  defects  of 
faulty  speech  are  hard  to  correct.     If  there  has  beea 

—152— 


DISEASES  OF  THE  MOUTH,  AND  FIRST  AID  REMEDIES 

no  operation  to  close  the  cleft  in  infancy,  the  person 
so  deformed  will  be  unable  to  articulate  words  prop- 
erly, becaus-e  of  the  defective  palate.  Thus  they  are 
deprived  of  distinct  speech,  and  do  not  properly  per- 
form the  work  of  mastication  and  the  swallowing  of 
food. 

An  operation  in  adult  life  seldom  fully  restores 
speech,  although,  if  the  defect  be  not  too  great,  an  op- 
eration will  often  do  much  good.  Dentists  have  de- 
vised an  appliance  to  close  these  openings  and  re- 
store speech  and  function  of  the  parts.  This  is  done 
by  means  of  an  artificial  plate,  with  attachments  to 
replace  the  lost  parts  of  the  hard  palate  or  soft 
palate.    These  appliances  are  called  obturators. 

If  the  hard  palate  only  is  perforated,  it  is  a  very 
easy  matter  to  close  the  cleft  by  means  of  an  artificial 
plate  to  cover  up  the  opening,  preventing  communica- 
tion between  the  mouth  and  nose. 

Where  the  hard  and  soft  palate  are  both  involved, 
the  construction  is  very  difficult.  In  such  cases  an  ar- 
tificial soft  palate  also  has  to  be  constructed  and  at- 
tached to  the  plate  to  restore  the  lost  part.  After  the 
''cleft  palate  speech"  has  been  developed,  it  is  neces- 
sary to  teach  the  patient  to  use  proper  speech.  This 
takes  time  and  patience,  both  on  the  part  of  the 
dentist  and  the  patient. 

Sometimes  the  hard  palate  is  perforated  by  disease. 
These  perforations  are  nearly  always  the  result  of 
syphilis.  They  may  be  all  the  way  from  a  single  hole 
through  the  hard  palate,  the  size  of  a  pea,  to  the  loss  of 

—153— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

most  of  the  palate  process  and  the  surrounding  tis- 
sues. The  first  care  should  be  thorough  constitution- 
al treatment,  to  prevent  further  destruction  of  tissue, 
and  prevent  the  patient  from  carrying  infection  to 
other  people.    This  is  the  physician's  work. 

Perforation  of  the  hard  palate  may  be  remedied 
by  the  use  of  a  plate  to  cover  up  the  opening  and 
prevent  communication  between  the  mouth  and  nose. 
This  will  restore  the  speech,  and  the  food  can  be  mas- 
ticated properly  and  swallowing  not  interfered  with. 

PYORRHEA. — Pyorrhea  will  probably  never  de- 
velop in  the  mouth  if  all  the  tooth  surfaces  have  always 
been  kept  clean.  When  teeth  are  allowed  to  become 
covered  with  deposits,  the  gums  are  irritated  from 
contact  with  the  deposits,  and  fall  an  easy  prey  to 
the  invasion  of  infection,  which  soon  causes  a  flow  of 
pus  from  around  the  teeth.  Pyorrhea  is  then  made 
possible  by  injury  to  the  gums,  and  infection  gets  an 
entrance  to  the  tissues  around  the  teeth.  The  first 
condition  usually  noted  by  patients  is  a  softening  of 
the  gums,  and  they  complain  of  the  gums  bleeding 
when  the  teeth  are  brushed. 

These  deposits  usually  form  around  the  necks  of 
the  teeth,  just  at  the  gum  margin,  and  if  left,  gradually 
push  back  the  gum  from  the  roots  of  the  teeth,  as 
the  deposits  become  heavier,  for  these  deposits  have 
a  tendency  to  increase  in  the  direction  of  the  roots. 

No  systemic  treatment  alone  is  able  to  arrest  this 
process.  Removal  of  the  deposits  and  prophylactic 
treatment  to  prevent  recurrence  of  the  condition  usu- 

—154— 


DISEASES  OF  THE  MOUTH,  AND  FIRST  AID  REMEDIES 

ally  give  good  results.  Emetine  Hydrochloride  is 
often  used  in  the  treatment  of  pyorrhea. 

In  connection  with  the  mechanical  removal  of  the 
deposits  and  prophylactic  measures,  there  may  be 
remedies  given  to  build  up  the  general  health,  if  this 
be  run  down. 

Medicine  alone  will  not  cure  pyorrhea,  and  to 
secure  good  results  the  mouth  must  be  kept  clean.  If 
deposits  are  allowed  to  accumulate  again,  the  disease 
will  return. 

If  disease  has  progressed  so  far  that  the  teeth  are 
loose,  and  the  alveolar  process  eaten  away,  the  best 
thing  to  do  is  to  extract  the  teeth.  If  pyorrhea  con- 
tinues long,  there  will  be  infection  carried  to  some 
other  organ  of  the  body.  Surgeons  find  that  most  of 
their  gall-stone  patients  have  pyorrhea.  Pyorrhea 
can  be  cured  if  treatment  is  begun  in  time,  and  when 
cured  it  takes  constant  care  to  prevent  its  return. 
Daily  massaging  of  the  gums  with  a  brush,  with  the 
use  of  a  good  tooth  powder,  will  keep  the  gums  firm 
and  the  teeth  free  from  deposits. 


-155— 


SOME  INFORMATION  ABOUT  DENTISTRY. 

CHAPTER  XII. 

The  people  of  a  country  constitute  society.  Laws 
are  made  to  govern  conduct  in  social  and  business 
affairs,  so  that  people  may  live  in  peace,  follow  their 
occupations,  and  justice  be  done  to  the  individual. 
Bankers  and  business  men  form  associations  and  make 
rules  for  the  conduct  of  their  business.  Laboring 
men  form  unions,  in  order  to  secure  a  just  compen- 
sation for  their  work,  and  to  better  their  living -con- 
ditions. 

Thus  the  banker  has  a  legal  rate  of  interest  on 
loans,  above  which  he  does  not  go,  while  the  loan 
shark  fleeces  his  victims,  and  is  therefore  held  in  bad 
repute.  The  business  man  recognizes  that  when  he 
makes  a  sale  the  purchaser  has  certain  rights,  and  is 
entitled  to  receive  a  fair  value  in  merchandise  in  re- 
turn for  his  money.  Thus  both  purchaser  and  mer- 
chant are  benefited  by  the  trade.  The  union  man 
looks  with  disfavor  upon  the  ''scab'',  because  he  takes 
an  unfair  advantage  of  the  union  man  in  labor  dis- 
putes. 

The  dentist,  like  the  rest  of  his  fellow  men,  has  his 
societies,  where  he  meets  with  his  brother  dentists  to 
discuss  dental    problems    and    improve    himself  in  a 

—156— 


SOME    INFORMATION   ABOUT    DENTISTRY. 

professional  way.  In  any  profession,  trade  or  calling^ 
there  will  be  found  men  who  abuse  the  privileges 
given  them.  Dentistry  is  not  exempt  from  this  rule, 
and  deception  and  ignorance  may  impose  upon  the 
layman  who  is  not  well  informed.  Dental  societies 
make  rules  to  govern  the  conduct  of  their  members 
toward  each  other,  and  the  conduct  of  dentists  toward 
their  patients.  One  of  the  principal  rules  is  in  regard 
to  advertising. 

ADVERTISING.  —  Reputable  dentists  class  the 
"advertising  quack"  with  the  loan  shark,  the  cut-rate 
man,  and  the  *'scab".  Bankers,  business  men,  and  the 
public,  sometimes  have  difficulty  in  understanding 
why  a  reputable  dentist,  or  a  physician,  considers  it 
wrong  to  advertise.  The  banker  and  business  man 
prospers  by  advertising.  Why  not  the  professional 
man  ? 

The  professional  man  may  and  does  profit  by  adver- 
tising, but  it  must  be  legitimate  advertising.  To  bet- 
ter understand  what  is  legitimate  advertising,  and 
what  is  not,  let  us  quote  four  rules  from  the  code  of 
ethics  which  govern  the  practice  of  reputable  dentists. 

Code  of  Ethics.  As  unanimously  adopted  by  the 
Illinois  State  Dental  Society,  1909.  From  the  Dental 
Review,  1909. 

''Section  I.  In  his  dealings  with  patients  and  with 
the  profession,  the  conduct  of  the  dentist  should  be 
in  accordance  with  the  Golden  Rule,  both  in  its  letter 
and  its  spirit. 

Section  II.  It  is  unprofessional  for  a  dentist  to  ad- 

—157— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

vertise  by  hand  bills,  posters,  circulars,  cards,  signs, 
or  in  newspapers,  or  in  other  publications,  calling  at- 
tention to  special  methods  of  practice,  or  claiming 
excellence  over  other  practitioners,  or  to  use  display 
advertisements  of  any  kind.  This  does  not  exclude 
a  practitioner  from  using  professional  cards  of  a 
suitable  size,  with  name,  titles,  address  and  telephone 
number,  printed  in  modest  type,  nor  having  the  same 
Mnd  of  a  card  in  a  newspaper.  Neither  does  it  pre- 
vent a  practitioner,  who  confines  himself  to  a  special- 
ty, from  merely  announcing  his  specialty  on  his  pro- 
fessional card. 

Section  III.  It  is  unprofessional  for  dentists  to 
pay  or  accept  commissions  on  fees  for  professional 
services,  or  on  prescriptions  or  other  articles  supplied 
to  patients  by  pharmacists  or  others. 

Section  IV.  One  dentist  should  not  disparage  the 
services  of  another  to  a  patient.  Criticism  of  work 
v^hich  is  apparently  defective  may  be  unjust,  through 
a  lack  of  knowledge  of  the  conditions  under  which  the 
work  was  performed.  The  duty  of  the  dentist  is  to 
remedy  any  defect  without  comment." 

The  dentist  who  conscientiously  follows  this  code 
cannot  go  far  wrong,  and  if  he  makes  mistakes  he 
will  profit  by  them,  and  not  make  the  same  mistake 
a  second  time.  The  patients  of  such  a  dentist  are 
given  good  service  and  fair  treatment.  He  will  not 
need  to  advertise,  for  his  patients  will  be  his  best 
advertisement,  and  success  will  come  through  their 
friendship. 

—158— 


SOME    INFORMATION    ABOUT    DENTISTRY. 

On  the  other  hand,  there  is  a  class  of  dentists  who 
seek  to  draw  their  patients  by  "boasting"  superiority 
and  ''catch  bait  bargain  prices."  Many  of  you  are 
familiar  with  the  gaudy  signs  and  alluring  adver- 
tisements of  these  quacks,  for  they  cannot  be  called 
by  any  other  name.  Often  the  owners  of  these  of-^ 
fices,  or  dental  parlors,  are  not  dentists  themselves, 
but  use  the  office  solely  as  a  commercial  venture,  and 
employ  students  or  recent  graduates  to  do  the  work. 

These  are  usually  without  ready  money,  or  are  in 
debt.  Some  of  them  drift  into  the  advertising  par- 
lors in  order  to  earn  some  ready  money,  and  to  get 
some  experience.  They  see  quick  work  in  the  dental 
parlors,  and  become  speedy  workmen  themselves.. 
They  advertise  low  prices,  and  have  to  work  quickly, 
for  time  is  money. 

Let  us  note  some  of  their  advertisements.  Gold 
crowns,  $3.00;  Cleaning  teeth,  50  cents;  Silver  fill- 
ings, 50  cents;  Plates  $5.00.  These  are  only  a  few  of 
the  ''catch  bait"  advertisements. 

CROWNS  FOR  $3.00.~How  can  a  reputable 
dentist  make  a  crown  for  $3.00?  The  time  taken  for  a 
proper  preparation  of  the  root  for  the  crown  is  worth 
that  much,  aside  from  the  material  used,  and  the  extra 
time  to  make  and  fit  the  crown. 

The  quack  makes  up  for  this  by  rapid  work,  and 
bj^  the  use  of  cheaper  material.  As  a  consequence, 
the  crown  does  not  fit  properly.  Often  the  gold  band 
is  crowded  up  under  the  gum  so  far  that  soreness  re- 
sults. In  a  few  years  the  tooth  is  lost  because  of 
pyorrhea,  which  develops  because  of  the  injury  done 

—159— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE  \ 

to  the  gums,  and  because    the  crown    collects    filth  j 

around  the  tooth.  ; 

TEETH   CLEANED   FOR   FIFTY   CENTS.—  No 

dentist  can,  on  the  average,  clean  a  set  of  teeth  in  less  ] 

than  an  hour.    When  the  deposits  are  very  bad,  it  may  j 

take  two  or  three  hours,  or  several  trips,  to  have  the  ■ 
work  done  properly.     No  dentist  can  work  for  fifty 

cents  an  hour  and  exist.  i 

How  can  the  quack  clean  teeth  for  fifty  cents?    By 
the  use  of  strong  acids  and  bleaches  the  work  of  hours 

may   be   done   in   a   few   minutes.     These   acids   and  i 

bleaches  also  destroy  the  teeth,  and  do  more  damage  j 

than  good.    The  teeth  may  look  nice  for  a  short  time,  j 

but  they  will  soon  show  the  effects  of  acid  and  bleach,  i 

turn  yellow,  and  the  destruction  wrought  is  greater  ! 

i 

than  that  which  years  of  wear  will  cause.  ■ 

SILVER  FILLINGS  FOR  FIFTY  CENTS.— Can  a  \ 

reputable  dentist    fill  teeth    for   fifty    cents,    and    do  i 

justice  to  himself  and  his  patient?    He  can  not.    The  ^ 

conscientious  dentist  will  cut  out  the  decay,  trim  the  ; 

cavity  so  that  when  the  filling  is  in  place  it  will    be  ; 

cleaned  by  the  act  of  chewing  food.     He  will  protect  ; 
the  tender  tooth  by  insulating  material,  so  that  the 
tooth  will  not  have  a  mass  of  metal  close  to  the  pulp 

or  ''nerve"   to  cause  it  to  ache.    A  tooth  filled  in  this  ] 

manner  will  be  comfortable  and  endure.     This  work  ! 
takes  time;   but  the  reputable  dentist  will  not  charge 

any  more  for  this  filling  than  the  quack  who  bores  ; 
three  or  four  little  holes  in  the  tooth,  and  charges  for 

that  many  fillings  at  fifty  cents  per  filling.     The  first  j 

—160—  i 


SOME    INFORMATION   ABOUT    DENTISTRY. 

class  work  will  endure,  while  the  other  kind  will  al- 
low decay  to  come,  and  the  tooth  soon  needs  a  new 
filling.  Poor  work  will  have  to  be  done  over  again, 
and  is  dear  at  any  price. 

PLATES  FOR  FIVE  DOLLARS.— With  the  usual 
care  the  expert  dentist  will  need  a  day  or  two  to  make 
a  set  of  artificial  teeth.  He  cannot  devote  this  much 
time  to  the  work  and  make  teeth  for  $5.00  per  "plate." 
Work  and  good  material  cost  more  than  that.  The 
work  requires  time  to  select  teeth  that  will  have  a 
natural  appearance.  It  requires  skill  in  order  to  se- 
cure an  accurate  fit.  The  result  must  be  such  that 
the  wearer  will  be  able  to  masticate  his  food  and 
speak  distinctly.    All  this  time  and  skill  costs  money. 

Dental  plates  are  made  over  models,  from  impres- 
sions of  the  mouth.  They  may  be  made  of  wax,  plaster 
of  paris,  or  modeling  compound.  The  wax  impressions 
are  easily  and  quickly  taken,  but  they  are  not  accurate. 
Those  of  modeling  compound  and  plaster  of  paris  are 
hard  to  make,  but  they  are  accurate.  The  man  who 
makes  plates  for  $5.00  will  use  the  quick,  cheap  way, 
but  the  results  will  not  be  satisfactory.  The  material 
used  will  be  inferior. 

Our  clothing  may  be  of  a  fine  grade,  or  it  may  be 
of  shoddy  material.  This  is  true  of  the  porcelain 
used  in  making  the  artificial  teeth.  There  are  two 
classes  of  porcelain,  a  high  grade  and  a  low  grade. 
The  better  grade  fuses  or  melts  at  a  high  heat.  It  is 
dense  and  not  easily  broken,  and  has  a  vital  or  lifelike 
appearance.    The  low  grade  is  less  dense  and  breaks 

—161— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

easily.  It  is  dull  and  lifeless  in  appearance.  The 
reason  that  the  quack  works  for  such  low  prices  is 
because  he  employs  poor  workmanship  and  uses  poor 
materials.  The  quack  works  a  few  hours  where  the 
careful  dentist  works  days. 

Teeth  are  not  luxuries.  They  are  necessities.  It  is 
therefore  poor  policy  to  buy  an  inferior  article  for  the 
sake  of  saving  a  few  dollars.  The  saving  is  not  real, 
for  the  poor  teeth  are  worthless  in  every  respect. 

The  greatest  sufferers  are  the  poorer  people,  and  the 
people  of  only  moderate  means.  Many  of  these  are  at- 
tracted by  the  cheap  prices  and  promises  of  quick 
work.  The  poor  deserve  our  sympathy.  However, 
the  poor  man  has  no  reason  for  resorting  to  the 
quack.  Any  good  dentist  expects  to  do  some  charity 
work,  and  some  work  for  much  less  than  his  usual 
fee,  for  those  who  cannot  afford  to  pay  the  regular 
prices.  In  many  places  free  dental  clinics  are  estab- 
lished for  those  who  are  unable  to  pay.  Here  he 
may  receive  careful  work  and  treatment  on  the  same 
basis  that  he  would  receive  medical  or  surgical  care 
from  our  medical  brethren. 

To  those  who  have  the  means  to  paj^  for  good  dental 
service,  experience  should  teach  them  that  anything 
abnormally  cheap  will  be  worthless.  For  these  there 
is  no  excuse.  For  poverty  and  ignorance  there  may 
be  an  excuse,  but  there  is  none  for  greed. 

FEES. — Conditions  which  regulate  the  cost  of 
living  in  a  community  will  have  their  effect  on  the 
cost  of  dental  services.    It  is  generally  conceded  that 

—162— 


SOME    INFORMATION    ABOUT    DENTISTRY. 

a  professional  man  is  entitled  to  fees  which  will  en- 
able him  to  live  in  comfort,  and  lay  up  a  com^petency 
against  the  day  that  he  will  be  unable  to  work,  the 
proverbial  "'rainy  day."  His  income  should  be  suffi- 
cient to  permit  him  to  live  on  an  equality  with  those 
he  serves,  and  with  the  people  with  whom  he  asso- 
ciates. If  prices  are  so  low  that  a  dentist  can  barely 
make  a  living  he  has  to  overwork  to  make  ends  meet. 
Worry  over  the  grocer's  bill,  the  meat  bill,  and  a 
hundred  other  little  worries,  impair  the  health  and 
the  efficiency  of  the  dentist,  and  lowers  the  grade  of 
service  to  his  patients.  Thus  they  all  suffer.  On  the 
other  hand,  the  dentist  who  charges  enough  for  his 
services  to  enable  him  to  live  in  comfort,  meet  his 
expenses,  and  lay  up  something  for  the  "rainy  day", 
will  be  free  from  these  petty  worries. 

He  can  devote  all  his  energies  to  the  service  of  his 
patients,  and  they  will  receive  a  higher  grade  of  ser- 
vice. The  relations  between  such  a  dentist  and  his 
patients  are  congenial.  He  establishes  a  family  prac- 
tice, patients  who  return  to  him  year  after  year. 
These  patients  may  pay  a  little  more  perhaps  than 
the  cheap  advertisers  would  charge  them,  but  they 
willingly  pay  it,  for  they  know  that  the  service  they 
receive  will  be  the  best  their  dentist  can  give,  re- 
gardless of  any  remuneration  they  may  paj^  him. 

I  have  endeavored,  in  this  chapter,  to  tell  of  the 
delusion  of  cheap  prices,  and  the  harm  one  may  suffer 
from  cheap  dentistry.  Prices  should  not  be  exorbi- 
tant;   neither  should  they  be  so  low  that  the  dentist 

—163— 


DENTAL  PHYSIOLOGY  AND  ORAL  HYGIENE 

cannot  make  a  decent  living.  For  then  the  quahty  of 
the  service  will  be  lowered,  and  the  patient  will  be 
the  principal  one  to  suffer.  The  health  of  the  body 
depends  to  a  great  extent  on  the  health  of  the  mouth. 
The  best  dental  service  should  be  employed  in  order 
to  maintain  good  health. 


It  has  been  said,  "There  is  nothing  new  under  the  sun."  This 
is  especially  true  of  the  information  contained  within  this  little 
book,  most  of  which  has  been  written  many  times,  and  is  known 
to  all  well  informed  dentists,  but  not  so  well  to  the  laity.  There- 
fore the  author  does  not  claim  any  originalitj^  except  perhaps,  in 
the  form  this  information  is  presented  to  the  reader. 


—164— 


GLOSSARY 


Abscess.  A  localized  collec- 
tion of  pus. 

Adenoid.  1.  Resembling  a 
gland.  2.  In  the  plural,  hy- 
pertrophy of  the  adenoid 
tissue  that  normally  exists 
in  the  naso-pharynx  of 
children  and  is  known  as 
pharyngeal,  tonsils. 

Adenoid- Vegetation.  Fungus 
like  growths  of  lymphoid 
tissue  in  the  nasal  pharynx. 

Aluminum.  A  white  metal 
with  a  bluish  tinge  resem- 
bling silver  but  inferior  to 
it. 

Alveolar-Abscess.  Pertaining 
to  an  inflammation  of  the 
alveolar-process. 

Alveolar-Process.  Pertaining 
to  the  process  which  sup- 
ports the  teeth. 

Anemia.  A  condition  in 
which  blood  is  deficient, 
either  in  quantity  or  quality. 

Anesthetic.  A  drug  that  pro- 
duces a  condition  without 
the  sense  of  touch  or  pain. 

Anesthetize.  To  render  in- 
sensible. 

Appendicitis.  Inflamation  of 
the  appendix  vermiformis. 

Areolar.  Containing  minute 
interspaces  or  lacunae. 

Bacteria.  Disease  germs. 
Microscopic  vegetable  or- 
ganisms. 

Bite.  The  position  of  the 
teeth  or  jaws  when  the 
mouth  is  closed.  Refers  to 
the  articulation  of  the  teeth. 

Bolus.  A  ball  of  food  ready 
to  swallow. 


Canker.  Ulceration  of  the 
mouth    or   lips. 

Carbohydrates.  A  compound 
made  up  of  carbon  in 
groups  of  six  atoms  and  of 
hydrogen  and  oxygen  in  the 
proportion  to  form  water. 

Catarrh.  Inflamation  of  a 
mucous  membrane  with  a 
free  discharge. 

Catarrhal  Stomatis.  Simple 
and  uncomplicated  inflam- 
mation and  redness  of  the 
mouth. 

Cathartic.     Purgative. 

Cauterize.  To  burn  or  sear 
with  caustics  or  a  hot  iron. 

Cementum.  The  layer  or 
bony  tissue  covering  the 
root  of  a  tooth. 

Cleft  Palate.  A  palate  hav- 
ing a  congenital  fissure  in 
the  median  line. 

Cocaine.  A  crystalline  alka- 
loid used  as  a  local  anes- 
thetic. 

Congenital.  Existing  at  or 
before  birth. 

Corium.  The  true  skin,  or 
dermis;  the  vascular  layer 
beneath  the  epidermis. 

Crown.  The  portion  of  the 
tooth  above  the  gum. 

Chystic-Duct.  The  excretory 
duct  of  the  gall  bladder. 

Debris.  Rubbish.  (Fragments 
of  food.) 

Decay.  The  gradual  decom- 
position of  dead  organic 
matter. 

Dentine.  The  chief  substance 
or  tissue  of  the  tooth  which 
surrounds  the  tooth  pulp. 


—165— 


GLOSSARY 


Dentition.  The  cutting  of  the 
teeth. 

Devitalizing;-.  Depriving  of  vi- 
tality or  of  life. 

Emetine.     A    white,    powdery 

alkaloid,  made  from  ipecac. 

Emetine        Hydrochloride.      A 

salt  of  emetine  employed  in 
-  medicine. 

Enamel.  The  white  compact, 
hard  substance  that  covers 
the   crown   of  the  tooth. 

Ethics.  Relating  to  rules  of 
professional   conduct. 

Ethyl  Chloride.  A  colorless 
liquid  used  as  a  local 
anesthetic  and  stimulant. 

Eiactachian  Tube.  The  pas- 
sage from  the  nasal  pharynx 
to  the  tympanum.  The  mid- 
dle ear  cavity. 

Fauces.  Tlie  passage  from 
the  mouth  to  the  pharynx. 

Fermentation.  The  chemical 
change  induced  by  a  fer- 
ment. 

Fissure.  Any  cleft  or  groove, 
normal  or  other. 

Frenulum.  Is  a  fold  of  the 
mucous  membrane  that  lim- 
its tlie  movement  of  an  or- 
gan in  part. 

Gall-stone.  A  calculus  from 
the  gall-bladder,  or  one  of 
its  afferent  ducts. 

Gastro-Intestinal.  Pertaining 
to  the  stomach  and  intes- 
tines. 

Germicide.  An  agent  that 
destroys  germs. 

Hy;;5ien.e.  Relating  to  the 
health  or  the  mode  of  pre- 
serving the  health. 

Inert.     Inactive. 

Infection.     The     implantation 

of  disease  from  witliout. 
Infectious.     Easily     spread 

from  person  to  person. 

—166 


Inflammation.  A  redness  and 
swelling  of  any  part  of  an 
animal   body. 

Integument.  The  covering  of 
the  bod^^ 

Kaolin.  A  fine  variety  of 
clay  used  in  making  porce- 
lain teeth. 

Layman.  Not  belonging  to, 
or  emanating  from,  a  par- 
ticular profession. 

Lymph.  A  t  r  a  n  s  p  a  r  e  nt, 
slightly  yellow  liquid  of 
alkaline  reaction  which  fills 
•  lymphatic  vessels. 

Malaria.  A  febrile  disease 
caused  by  a  blood  parasite. 

Malleable.  Capable  of  being- 
shaped  or  beaten. 

Massage.  A  systematic  ther- 
apeutic friction,  stroking, 
and  kneading  of  the  body. 

Mastication.  A  chewing  of 
food. 

Metabolism.  The  process  by 
which  living  cells  or  organ- 
isms incorporate  the  matter 
obtained  from  food  into  a 
part  of  their  own  bodies. 

Mucus.  The  viscid,  watery 
secretion  of  the  mucous 
glands.  It  is  con.posed  of 
water,  mucin,  inorganic 
salts,  epithelial  cells,  leu- 
cocjdes  and  granular  mat- 
ter. 

Mucous.  Pertaining  to  or  re- 
sembling mucus. 

Naris.      A   nostril    (pi.   nares). 

Uecrc-i"..  A  molecular  death 
of  t'ssue. 

Neural  jia.  Pain  in  a  nerve 
or  radiating  along  the 
cburse  of  a  nerve,  of  a 
severe  darting  character. 

Ni-jht  terrors.      Night    frights. 

Nitrogenous.  Containing  ni- 
trogen. 

Nitrous  Oxide.  A  non-as- 
phyxial  anesthetic  agent. 


GLOSSARY 


Node.  A  swelling  or  pro- 
tuberance. 

Nodules.  A  small  boss  or 
node. 

Novocaine.  A  local  anesthe- 
tic. 

Oral   Hygiene.      Pertaining   to 

the  health  of  the  mouth. 
Organism.     Any       individual 

plant   or   animal. 
Orthodontia.      The    correction 

of  dental  irregularities. 
Oxygen.     A    gaseous    element 

existing  free  in  the  air. 

Papilla.  Any  small  nipple- 
shaped  elevation. 

Pathological.  Pertaining  to 
the  causes  and  symptoms  of 
diseases. 

Peridental.  Situated  or  oc- 
curring around  a  tooth. 

Pericementum.  The  me  m- 
brane  or  tissue  which  oc- 
cupys  the  space  between  the 
root  of  a  tooth,  and  the 
alveolus  of  the  jaw. 

Platinum,  A  metal  resem- 
bling silver,  very  ductile 
and  malleable,  and  fuses 
only  at  a  very  high  tem- 
perature. 

Porcelain.  A  composition  of 
feldsnar,  silica,  kaolin. 

Prophylactic.  A  remedy  to 
ward  off  disease. 

Pulp.  The  soft  vascular  tis- 
sue occupying  the  center  of 
the    tooth. 

Pus.  A  liquid  inflammation. 
The  matter  of  a  sore. 

Putrofacticn.  The  decompo- 
sition of  vegetable  and  ani- 
mal   matter. 

Pyorrhea.  A  discharge  of 
pus,  with  progressive  nec- 
rosis of  the  aveoli  and  loose- 
ness of  the  teeth. 


Quack.  An  ignorant  or 
fraudulent  empiric. 

Remuneration.  Compensation 
given   for   services. 

Rheumatism.  An  inflamma- 
tion of  the  connective-tissue 
structures  of  the  body. 

Rickets.  A  disease  of  child- 
hood in  which  the  bones  be- 
come soft  and  flexible. 

Ruga.  A  ridge,  wrinkle,  or 
fold. 

Saline  Laxative.  A  laxative 
of  salts. 

Sanitary.  Promoting  or  per- 
taining to  the  health. 

Scab.      A  non-union  worker. 

Sepsis.  Poisoning  by  the  pro- 
ducts of  putrefactive  pro- 
cess. 

Synthetic.     Artificial. 

Syphilis.  A  contagious  and 
hereditary  venereal  disease. 

Tartar.     The     incrustations 

formed  on  neglected  teeth. 
Taut.     Tight.  Not  slack. 

Tonsils.  A  small  mass  be- 
tween the  pillars  of  the 
fauces  on  either  side. 

Ulceration.  The  formation 
of  an  open  sore  other  than 
a  wound. 

Vitally.  That  which  is  essen- 
tial to  life. 

Vitamines.  Substances  exist- 
ing in  foods  which  are 
necessary  to  proper  meta- 
bolism, and  absence  of  which 
produce  deficiency,  diseases 
such  as  beriberi. 


^167- 


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